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Law enforcement seizures of pills containing fentanyl increased dramatically between 2018-2021, U.S. study finds: Research highlights growing, dangerous trend, particularly for people new to drug use -- ScienceDaily | This study was published today in Drug and Alcohol Dependence and funded by the National Institute on Drug Abuse ( NIDA), part of the National Institutes of Health. According to the most recent Centers for Disease Control and Prevention data, the United States hit a record high in the number of overdose deaths ever recorded, estimating that nearly 106,000 people died from drug overdoses in the 12-month period ending in October 2021. This rise is largely driven by illicit fentanyl and other synthetic opioids.
Illicit fentanyl is highly potent, cheaply made and easily transported, making it a profitable narcotic. While people may seek out illicit fentanyl intentionally, many people are not aware that the drug they are using -- including heroin, cocaine, methamphetamine, or benzodiazepines -- may actually be fentanyl, or has been adulterated or contaminated with fentanyl. Because fentanyl is about 50 times more potent than heroin and a lethal dose may be as small as two milligrams, using a drug that has been laced with fentanyl can greatly increase overdose risk.
`` An increase in illicit pills containing fentanyl points to a new and increasingly dangerous period in the United States, '' said NIDA Director Nora D. Volkow, M.D. `` Pills are often taken or snorted by people who are more naïve to drug use, and who have lower tolerances. When a pill is contaminated with fentanyl, as is now often the case, poisoning can easily occur. ''
Illicitly manufactured powder fentanyl has been a known adulterant in drugs since 2013, but the extent that fentanyl is found in counterfeit pills has been largely unknown. To address this question, a team led by Joseph J. Palamar, Ph.D., M.P.H., associate professor at the NYU Grossman School of Medicine and co-investigator on the NIDA-funded National Drug Early Warning System ( NDEWS), analyzed data on drug seizures by law enforcement. The data were collected between January of 2018 and December of 2021 from the High Intensity Drug Trafficking Areas ( HIDTA) program, a grant program aimed at reducing drug trafficking and misuse administered by the Office of National Drug Control Policy in which the Drug Enforcement Administration and the CDC play an active role.
Comparing data from the first quarter of 2018 with the last quarter of 2021, the team found that the number of seizures of pills containing fentanyl increased from 68 to 635, and the total number of individual pills seized by law enforcement increased from 42,202 to 2,089,186. Seizures of powder containing fentanyl also increased from 424 to 1,539, and the total weight of powder seized increased from 298.2 kg to 2,416.0 kg.
Unlike most survey data and surveillance systems which can be lagged for a year or more, HIDTA data are made available quarterly, allowing evaluation in almost real time. HIDTA also distinguish between the presence of fentanyl in pill or powder form. Analyzing these data can therefore help identify trends in availability of illicit substances and act as a type of early warning system to shift public health education or interventional resources more quickly.
HIDTA data does not differentiate between fentanyl and its analogs, nor estimate the amount of fentanyl present in seized substances; however, given the small amount necessary for an overdose, the authors note that the presence of any fentanyl is an important indicator of overdose risk. People who purchase counterfeit drugs, such as illicit oxycodone, hydrocodone, or benzodiazepines may be at risk for unintentional exposure to fentanyl, which is associated with increased risk of overdose death. Further, people who use these types of pills are less likely to have a tolerance built to opioids, and when coupled with the sedative effects of non-fentanyl opioids or benzodiazepines, may further increase risk of overdose and death.
`` For the first time we can see this rapid rise in pills adulterated with fentanyl, which raises red flags for increasing risk of harm in a population that is possibly less experienced with opioids, '' said Dr. Palamar. `` We absolutely need more harm reduction strategies, such as naloxone distribution and fentanyl test strips, as well as widespread education about the risk of pills that are not coming from a pharmacy. The immediate message here is that pills illegally obtained can contain fentanyl. ''
The researchers emphasize that drug seizure rates are not direct measures of actual drug availability. However, the increase in fentanyl-related drug seizures coincides with increasing synthetic opioid-related overdose death rates. These data also corroborate data from the DEA National Forensic Laboratory Information System showing a steady increase in fentanyl seizures in recent years, even across the earlier parts of the COVID-19 pandemic. For additional NDEWS research and reports, visit: https: //ndews.org/
`` To address the overdose crisis, you need real-time, high-quality drug surveillance data to inform the public health response, '' said Linda B. Cottler, Ph.D., M.P.H, principal investigator of NDEWS, and last author on the paper. `` Through collecting and sharing data on drug use trends as we do through our NIDA-funded NDEWS, we aim to guide strategies to curb the overdose crisis of today, while also keeping our eye on the horizon to prepare for the problems of tomorrow. '' | science |
China reopens one city as Shanghai lockdown enters a second phase | The city of Shanghai is preparing to reopen its eastern half and shut its western half, while authorities elsewhere announced the lifting of a citywide lockdown in the province hit hardest by China’ s omicron-driven coronavirus outbreak.
Residents of the city of Jilin will be able to move about freely starting from Friday for the first time in more than three weeks. They will be required to wear masks and, when indoors, stay one meter apart. Public gatherings in parks and squares are prohibited.
The spread of Covid-19 has been brought under control in Jilin city but not in the rest of Jilin province, officials said at a news conference.
Some progress has been made in Changchun, the provincial capital and a car manufacturing hub that has been locked down since March 11.
China has been battling its largest Covid-19 outbreak since the initial one in early 2020 that devastated the city of Wuhan and other parts of Hubei province. | general |
World Backup Day 2022: Reflect on Data Protection to Combat Cyberattacks | Join Our Telegram Channel for More Insights. Join Now
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World Backup Day 2022 is here today, March 31, 2022, for all business leaders to take out some time off their busy schedules to reflect on the utmost important data protection issue. We have been experiencing innumerable cyberattacks on the vast amounts of large datasets with confidential and sensitive information across the world. Cybercriminals are improving their modern approaches to hack, steal, blackmail, and demand random ransomware from companies or individuals. For having effective data management efficiently, one needs to focus on data backup through a data protection system. World Backup Day gives us a chance to defend essential data against modern cyberattacks. Let’ s get to know more about World Backup Day and how tech leaders celebrate this day for data protection.
The constant advancements in cyberattack approaches from the dark web have made the global tech market and all other industries worry about the existing data. It is evolving with time and methods and no company knows when and how these cyberattacks will harm computer systems. The emergence of the COVID-19 pandemic has also contributed to the more use of smart devices and the supply of real-time data from different sources. Multiple groups of cybercriminals are always on the verge to seek weak links for selling data to the dark web.
Thus, World Backup Day helps to raise the necessary awareness of the need for data protection through necessary data backup methods. Organizations should be aware of the existing advancements in data protection tools with cutting-edge technologies such as artificial intelligence, IoT, machine learning, cloud computing, etc. It helps in effective data management while combating potential cyberattacks.
Data backup is a traditional process of making three or more copies to store the essential confidential data and folders for utmost data protection. This helps when one data storage is lost, for, it can be retrieved after the data loss. Even if the data management process is flawless, there are opportunities for virus attacks or corruption of files from potential cyberattacks. Thus, companies need to understand the importance of data backup through World Backup Day.
Organizations need to be well-informed about the current data backup processes to adapt to the evolving cyberattack space. There should be meetings and conferences to explain the importance of effective data management with necessary data backup strategies. Data protection can be beneficial to both organizations and stakeholders for maintaining the existing brand loyalty.
Anshuman Rai, Area Vice President, India & South Asia, Commvault, said: “ The alarming rate of ransomware attacks has put cyber hygiene and data management at the centre of all businesses. In fact, the virtual-first approach leading to collaborative technology and increasing cloud adoption has redefined the role of CIOs. The value of data safekeeping, regular backups, cloud data protection of workloads in your cloud and multi-cloud environments hold the key for businesses to be future-ready and drive maximum value in the digital world. ”
He added that one of the most vital elements of data protection is how quickly lost data can be recovered, thus, emphasizing the importance of World Backup Day. Today serves as an annual reminder to get data backups in order so that when the worst does happen, the data can be recovered quickly without seriously impacting business continuity.
While talking about establishing a better backup, Anshuman noted, “ Businesses must identify the desired outcome to smartly back up their data. To achieve this, they must consider the recovery requirements and evaluate the market trends and solutions best suited for their needs. For instance, Software-as-a-Service ( SaaS) solutions have become very popular in India due to its cost-effectiveness, scalability, and flexibility, enabling users to roll out data protection capabilities quickly and smoothly, backup data while avoiding the expense of building and maintaining tailor-made data protection solutions. ”
Sandeep Bhambure, Vice President, Veeam Software- India & SAARC, commented, “ It is evident that the dependency of businesses on data, and the amount of data generated by them is consistently growing. This is creating new challenges for organisations of all sizes, making them even more vulnerable to cyberattacks. According to Veeam Data Protection Report 2022, 84% of Indian organizations suffered ransomware attacks, making cyber-attacks one of the single biggest causes of downtime for the second consecutive year. The report also found that Indian organizations were unable to recover 36% of their lost data on average and 90% of organizations were unable to recover at least some of the data they had lost. Hence, it is essential that businesses have a comprehensive data backup plan in place to be fully prepared at the time of a data breach. That’ s not all! Only backing up may not protect your data from ransomware – it is equally important to ensure that the backup is well protected and securely stored. Organizations need to ensure their data protection capabilities keep pace with the demands of their business, to close the gap between how much data they can afford to lose after an outage versus how frequently data is backed up.
The good news is that we’ re seeing CXOs acknowledge the urgent need for Modern Data Protection. And investing in such technologies goes beyond providing peace of mind, ensuring business continuity, and maintaining customer confidence. ”
Ripu Bajwa, Director, and General Manager, Data Protection Solutions, Dell Technologies India pointed out, “ In today’ s era of accelerated change and digital transformation, businesses in every sector need to do more with less. With businesses in India running workloads in a hybrid environment, it is critical to securely store data in multiple spaces like databases, file servers, and network-attached storage ( NAS). While considering a solution that gives businesses the flexibility to access, upload, protect and analyze data, an asset that will have the advantage of long-term retention, reporting, and insight into cloud storage use, will serve Indian organizations better. Data use and storage have undergone dynamic changes. According to the Dell Technologies APEX Backup Services study, 65% of IT decision-makers lack confidence that they will recover all systems or data to meet SLOs following a data loss. An as-a-Service model can be a redefining solution for businesses across where an enterprise solution provider manages their data needs while they focus on business growth. 25% of IT decision-makers indicate that database or data management workloads are a good fit for the as-a-Service model. ”
“ As a global leader in data protection solutions, Dell Technologies’ enterprise backup solutions can protect everything from laptops and other edge devices to the largest enterprise data centre, along with data and applications residing in on-premises infrastructure, and virtualized environments including public, private, and hybrid clouds. With many options for backup storage, backup software, integrated appliances, and data protection and recovery solutions, Dell Technologies makes it easy to implement powerful tools for backup, recovery, data archiving, and data replication that can help to protect business-critical data, improve uptime and ensure data availability. Dell Technologies’ new SaaS-based Apex Backup Services offers end-to-end scalable, secure data protection with centralized monitoring and management for SaaS applications, endpoints, and hybrid workloads, ” he added.
Ripu continued that this World Backup Day should be a welcome opportunity for businesses to reconsider their storage solutions and upgrade to safer cloud environments secured by cutting-edge data protection amenities, which will support their digital transformation journey.
Jeff Costlow, CISO of ExtraHop, spoke briefly on Word Backup Day, “ Ransomware is a shadow that hangs over all organizations today. This World Backup Day should be a call for all organizations to examine how their backup and recovery plan weaves into their overall security strategy to ensure they are protected in the event of a ransomware attack. Sadly, organizations must take further precautions and can not rely solely on their data backups. Today’ s ransomware has become an advanced threat with the ‘ hat trick’ of exfiltration, encryption, and software exploitation. It used to be that the sole endgame of ransomware was encryption. Deploy the ransomware, encrypt the files, and demand payment in exchange for the keys. Today, ransomware criminals have introduced payment incentives at multiple steps in the killchain, from exfiltration of data to exploitation of the software. While it is key for organizations to ensure a strong backup and recovery strategy is in place for business continuity, they can no longer guarantee that their private data won’ t be released.
A backup plan is just the beginning. Other points to consider in a ransomware response plan include:
Initial access: This is where cybercriminals gain a foothold through a wide range of techniques proven effective over time, including phishing emails. Ensure you have user training in place and strong preventative measures including VPNs and firewalls.
The midgame: This is where the attacker pivots through an organization’ s infrastructure, accumulating assets and compromising data. Organizations need strong visibility into East-West traffic to spot ransomware, including lateral movements, domain escalations, command and control actions, and data staging.
The extortion cycle: Cybercriminals have compromised your systems and your data. A strong backup and recovery process is a critical piece of the puzzle that will keep your business up and running. ”
Last, but not least, Kumar Vembu, CEO and Founder of Gofrugal, said, “ Data is the new oil, said a sane soul. The only difference is that oil would run out in a few years. Data, on the other hand, keeps getting accumulated exponentially. With more than 50% of the world’ s population using smartphones and digital devices, with new ones adding day by day, there are massive amounts of data created.
We walk, talk, eat, drink and breathe data. We are constantly leaving behind digital footprints. More so, when we engage with online platforms and are engrossed with digital channels. What most of us fail to notice, far less comprehend, is the lurking dangers and sneaking threats that we invite unintentionally. We hardly realize the growing platforms using AI + data to understand our choices and apprehend our preferences and use our own personal information to create personalized experiences.
It’ s time we all woke up to the realities and compulsions of data protection at large. It’ s not just about data backup and restores methods, but it’ s also about freeing businesses from digital slavery. It is the capacity to decide what data should be stored, how it should be used or not used, and to make sure it doesn’ t make us enslaved by hardware and enchained by software.
It’ s not just individuals who are unaware and unprotected. Over, 90% of small and medium-size retail and distribution businesses are not aware of the impact of data protection. According to a global survey by a cybersecurity firm, 57% of organizations suffered unexpected downtime last year because of data loss. The findings also revealed that while 91% of individuals backup data and devices, 68% still lose data because of hardware or software failures, out-of-date backup, power fluctuations, theft or accidental deletion. The backup methods are not regular and sometimes even a day’ s or week’ s day is lost because of manual methods.
This World Backup Day, businesses need to understand and commit to the importance of data backup and enjoying the freedom of sharing data in a secure environment. It is high time the world moves from celebrating the Backup Day to daily backup! ” | tech |
Ukraine president addresses parliament; Putin a ‘ war criminal’, PM says – as it happened | Volodymyr Zelenskiy says Australian contribution to become more critical as Scott Morrison pledges extra $ 25m in military assistance to Ukraine; Sydney rainfall tops record set in 1956; flood and hazardous surf warnings across NSW; nation records 32 Covid deaths. This blog is now closed
Nino Bucci, Tory Shepherd and Calla Wahlquist
Thu 31 Mar 2022 09.29 BST First published on Wed 30 Mar 2022 21.29 BST
9.18am BST 09:18
That’ s it for today, thanks for reading. Here’ s a recap of the day’ s main stories:
We will see you all back here tomorrow.
Updated at 10.14am BST
9.07am BST 09:07
We’ ll be closing this up shortly, but a full story on Labor’ s budget reply will be up on the site in the next hour or so.
8.54am BST 08:54
Just a reminder that we’ re expecting to hear the budget reply speech of opposition leader Anthony Albanese in the next five minutes or so.
8.53am BST 08:53
AAP have filed a full report on the address of Ukrainian president Volodymyr Zelenskiy to a joint sitting of Australian parliament:
Ukrainian president, Volodymyr Zelenskiy, has told Australia’ s parliament the essence of the country’ s dream is still alive as he asked for more military aid.
To a standing ovation from parliamentarians and the viewing gallery, the defiant president appeared via videolink and proclaimed Russia’ s aggression as a real threat to Australia.
“ That is the nature of evil - it can instantly cross any distance, any barriers, destroy lives, ” he said.
“ Unpunished evil comes back with inspiration and a feeling of almightiness. ”
Zelenskiy said the invasion of his country wouldn’ t have happened if Russia was held accountable for the shooting down of MH-17 in 2014.
“ We have to correct some horrible mistakes and correct them now, ” he said.
“ We need new sanctions against Russia until they stop blackmailing other countries with their nuclear missiles. They have to pay the highest price. ”
The Ukrainian president asked for access to Australian military vehicles such as the Bushmaster.
“ That could help Ukraine significantly - we would be very grateful if you could share those with us, ” he said.
Zelenskiy also invited Australia to help with the restoration of the country’ s coastal cities.
“ The geographical distance between us is huge, but what does this distance mean for those who have a common understanding?
“ Geography doesn’ t matter. ”
Prime minister, Scott Morrison, used his opening remarks to announce a further $ 25m of defensive military equipment for Ukraine and to brand Russian president, Vladimir Putin, as the “ war criminal of Moscow ”.
The package includes tactical decoys, unmanned aerial and ground systems, rations and medical supplies.
“ Ukraine and Australia are separated by half the earth. Our languages, accents, histories and cultures are different but we share an affinity for democracy or freedom, ” Morrison said.
“ Mr President, you have our praise. But you also have our weapons, our humanitarian aid, our sanctions against those who seek to deny your freedom. ”
Morrison also pledged to help Ukraine rebuild following the war, praising the “ strong people of an indomitable country ”.
Opposition leader, Anthony Albanese, likened Russia’ s invasion to the devastation wrought by Hitler in the second world war, saying Putin’ s aggression was prefaced by a “ poisonous, nationalistic lie ”.
“ As you stand up to this latest tyrant, you are showing us what true courage is, ” Albanese said.
“ It is the courage that is embodied by you ( President Zelenskiy). You are fighting for your country and your people. ”
The government’ s aid package was announced alongside an additional 35% tariff for all imports coming from Russia and Belarus on top of general duties that already apply.
Australia has also granted almost 5600 visas for people in Ukraine, more than 1400 of whom have since arrived.
Australia is providing $ 91m in military assistance, $ 65m in humanitarian assistance and 70,000 tonnes of thermal coal to meet Ukraine’ s energy needs, as well as temporary protection visas and support for Ukrainian community groups in Australia.
There are also targeted sanctions on individuals and entities, the prohibition of energy, oil and gas products from Russia, and a ban on exports of alumina and bauxite to Russia.
with Reuters
Updated at 9.00am BST
8.47am BST 08:47
It must be said that Brighton is hardly the most exciting suburb in Melbourne, but I guess this still would have been something of a thrill.
One of Melbourne's most upmarket suburbs is buzzing after a brush with royalty. Princess Mary has been spotted in Brighton. https: //t.co/5zYfOfohG3 @ paul dowsley # 7NEWS pic.twitter.com/eXlGUs8Y8b
8.40am BST 08:40
Here is our full story on the failed bid to take the Liberal pre-selection stoush to the high court.
Updated at 8.49am BST
8.32am BST 08:32
Still waiting on offical word on this helicopter crash, but the signs aren’ t good.
Five people are feared to have been killed in one of Victoria's worst air disasters, after a helicopter crashed near Mount Disappointment, north of Melbourne. https: //t.co/bd8AOUzdnk @ cassiezervos @ emma os # 7NEWS pic.twitter.com/gjRSANNkx1
8.30am BST 08:30
Missed this among the more incendiary valedictory speeches...
Former House of Representatives Speaker Tony Smith uses his final speech to gently criticise MP's who 'needlessly and consistently ' shout in the chamber. He told Parliament the loudness of an MP's voice does not boost the quality of the points they're making.Word. # auspol
8.26am BST 08:26
This at first glance does not particularly sound like what you’ d want to hear if your house had been flooded for the second time in a month. Story via AAP:
Australia’ s disaster relief agency boss says crisis-affected people now expect governments will “ just step up and pick up the pieces ”.
Shane Stone, Coordinator-General of the National Recovery and Resilience Agency, told a Senate estimates committee on Thursday he “ continuously ” found Australians now recovering from disasters expected the “ taxpayer will step up ”.
“ We’ ve probably lifted the bar so high, that there is now an expectation that state and federal government will just step up and pick up the pieces, ” he said.
“ Now, that’ s not a criticism, that’ s a fact. That’ s where we are in Australia at the present time. ”
He cited a flood in the North Queensland town of Charters Towers in the 1970s, where people “ just got on with it ”.
Stone, a former Northern Territory chief minister and Liberal party president, was appointed to the position by the federal government in 2019.
Earlier, the hearing was told government officials discussed a national emergency declaration as NSW flooded, 10 days before Scott Morrison made the announcement.
A senior official from the department of prime minister and cabinet told senators members of the government’ s crisis and recovery committee considered a declaration at three meetings in the lead-up to the prime minister’ s announcement.
The first meeting discussing the possibility was on 27 February. Lismore’ s flood levee was breached a day later.
Two other meetings followed, with the final held a day before the declaration.
“ As we watched the persistent nature of the weather event unfold, we realised we were watching something that might lead us down that path, ” the official told the hearing.
Morrison visited Lismore on 9 March, after his Covid-19 isolation, and declared a national emergency the same day.
He defended the delay, telling parliament the state of emergency assists with recovery efforts after the flood.
“ It does not trigger payments or ADF involvement, ” he said in question time on Thursday.
“ Those two things are the things we did immediately. ”
An emergency declaration gives the federal government the ability to quickly send resources and respond to disasters by streamlining processes.
The hearing was told the decision to make the declaration rested with the prime minister, who had to be satisfied the crisis could cause “ nationally significant harm ”.
The prime minister told parliament he consulted with the premiers of Queensland and NSW before making the declaration.
“ The premier of Queensland did not wish us to declare a state of emergency in Queensland, I listened to her and I took her advice. The premier of NSW was happy ( for us) to do so, ” he said.
Labor senator Murray Watt asked if Morrison had waited to make the announcement once he had come out of isolation for the publicity and media attention.
“ This is a prime minister who is well known for his addiction to marketing and making announcements, ” Watt said.
“ You’ re telling me it’ s just a coincidence that he waited until the day he came out of isolation when he could be in Lismore surrounded by TV cameras, before he declared a national emergency. ”
Finance minister, Simon Birmingham, hit back at the accusation and said Watt “ enjoyed a cheap shot ”, as the declaration was made following the latest meeting by officials providing information.
Updated at 8.33am BST
8.13am BST 08:13
Ukrainian Pres Zelenskyy talking about the unpunished evil of the shooting down of MH17 in 2014, and how the failure to hold those responsible to account contributed in part to Russia's confidence in going ahead with invasion. Address to Aus Parlt live on @ abc news channel now pic.twitter.com/CsTueCnIRU
8.09am BST 08:09
Zelenskiy says Ukraine's `` dream is undefeatable '' if it can count on the global community's supportAustralia has just announced $ 25m more in military support - Zelenskiy says he would be `` very grateful '' for vehicles to be donated, like Australia's Bushmaster armoured trucks
8.07am BST 08:07
Some reaction coming through on the address of the Ukrainian president Volodymyr Zelenskiy:
Just watched a powerful address from President Zelenskyy to the Aust Parliament.The @ Greens are in firm solidarity with the people of Ukraine, the protestors in Russia & everyone impacted by the war. pic.twitter.com/320FiTwxiL
7.58am BST 07:58
Let’ s reiterate some of Zelenskiy’ s main points:
Updated at 7.59am BST
7.55am BST 07:55
Speaker Andrew Wallace again thanks Zelenskiy and gives him and the Ukrainians our prayers, and the screen goes black.
Updated at 8.00am BST
7.53am BST 07:53
Zelenskiy has finished his address with “ Slava Ukraini ”, and is met with a standing ovation.
7.53am BST 07:53
Just reiterating that Zelenskiy is speaking via a translator, so this is a little hard to follow in places, but the thrust of it is that there’ s much to be done, he is grateful for our support so far, but more is needed, and more will be needed once the conflict is over.
7.52am BST 07:52
He said:
We invite prominent countries of the world, leading countries, and the best experts, to join the project and restoration of Ukraine. | general |
Risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals with natural and hybrid immunity: a retrospective, total population cohort study in Sweden - The Lancet Infectious Diseases | BackgroundReal-world evidence supporting vaccination against COVID-19 in individuals who have recovered from a previous SARS-CoV-2 infection is sparse. We aimed to investigate the long-term protection from a previous infection ( natural immunity) and whether natural immunity plus vaccination ( hybrid immunity) was associated with additional protection.MethodsIn this retrospective cohort study, we formed three cohorts using Swedish nationwide registers managed by the Public Health Agency of Sweden, the National Board of Health and Welfare, and Statistics Sweden. Cohort 1 included unvaccinated individuals with natural immunity matched pairwise on birth year and sex to unvaccinated individuals without natural immunity at baseline. Cohort 2 and cohort 3 included individuals vaccinated with one dose ( one-dose hybrid immunity) or two doses ( two-dose hybrid immunity) of a COVID-19 vaccine, respectively, after a previous infection, matched pairwise on birth year and sex to individuals with natural immunity at baseline. Outcomes of this study were documented SARS-CoV-2 infection from March 20, 2020, until Oct 4, 2021, and inpatient hospitalisation with COVID-19 as main diagnosis from March 30, 2020, until Sept 5, 2021.FindingsCohort 1 was comprised of 2 039 106 individuals, cohort 2 of 962 318 individuals, and cohort 3 of 567 810 individuals. During a mean follow-up of 164 days ( SD 100), 34 090 individuals with natural immunity in cohort 1 were registered as having had a SARS-CoV-2 reinfection compared with 99 168 infections in non-immune individuals; the numbers of hospitalisations were 3195 and 1976, respectively. After the first 3 months, natural immunity was associated with a 95% lower risk of SARS-CoV-2 infection ( adjusted hazard ratio [ aHR ] 0·05 [ 95% CI 0·05–0·05 ] p < 0·001) and an 87% ( 0·13 [ 0·11–0·16 ]; p < 0·001) lower risk of COVID-19 hospitalisation for up to 20 months of follow-up. During a mean follow-up of 52 days ( SD 38) in cohort 2, 639 individuals with one-dose hybrid immunity were registered with a SARS-CoV-2 reinfection, compared with 1662 individuals with natural immunity ( numbers of hospitalisations were eight and 113, respectively). One-dose hybrid immunity was associated with a 58% lower risk of SARS-CoV-2 reinfection ( aHR 0·42 [ 95% CI 0·38–0·47 ]; p < 0·001) than natural immunity up to the first 2 months, with evidence of attenuation thereafter up to 9 months ( p < 0·001) of follow-up. During a mean follow-up of 66 days ( SD 53) in cohort 3, 438 individuals with two-dose hybrid immunity were registered as having had a SARS-CoV-2 reinfection, compared with 808 individuals with natural immunity ( numbers of hospitalisations were six and 40, respectively). Two-dose hybrid immunity was associated with a 66% lower risk of SARS-CoV-2 reinfection ( aHR 0·34 [ 95% CI 0·31–0·39 ]; p < 0·001) than natural immunity, with no significant attenuation up to 9 months ( p=0·07). To prevent one reinfection in the natural immunity cohort during follow-up, 767 individuals needed to be vaccinated with two doses. Both one-dose ( HR adjusted for age and baseline date 0·06 [ 95% CI 0·03–0·12 ]; p < 0·001) and two-dose ( HR adjusted for age and baseline date 0·10 [ 0·04–0·22 ]; p < 0·001) hybrid immunity were associated with a lower risk of COVID-19 hospitalisation than natural immunity.InterpretationThe risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals who have survived and recovered from a previous infection remained low for up to 20 months. Vaccination seemed to further decrease the risk of both outcomes for up to 9 months, although the differences in absolute numbers, especially in hospitalisations, were small. These findings suggest that if passports are used for societal restrictions, they should acknowledge either a previous infection or vaccination as proof of immunity, as opposed to vaccination only.FundingNone.
Real-world evidence supporting vaccination against COVID-19 in individuals who have recovered from a previous SARS-CoV-2 infection is sparse. We aimed to investigate the long-term protection from a previous infection ( natural immunity) and whether natural immunity plus vaccination ( hybrid immunity) was associated with additional protection.
In this retrospective cohort study, we formed three cohorts using Swedish nationwide registers managed by the Public Health Agency of Sweden, the National Board of Health and Welfare, and Statistics Sweden. Cohort 1 included unvaccinated individuals with natural immunity matched pairwise on birth year and sex to unvaccinated individuals without natural immunity at baseline. Cohort 2 and cohort 3 included individuals vaccinated with one dose ( one-dose hybrid immunity) or two doses ( two-dose hybrid immunity) of a COVID-19 vaccine, respectively, after a previous infection, matched pairwise on birth year and sex to individuals with natural immunity at baseline. Outcomes of this study were documented SARS-CoV-2 infection from March 20, 2020, until Oct 4, 2021, and inpatient hospitalisation with COVID-19 as main diagnosis from March 30, 2020, until Sept 5, 2021.
Cohort 1 was comprised of 2 039 106 individuals, cohort 2 of 962 318 individuals, and cohort 3 of 567 810 individuals. During a mean follow-up of 164 days ( SD 100), 34 090 individuals with natural immunity in cohort 1 were registered as having had a SARS-CoV-2 reinfection compared with 99 168 infections in non-immune individuals; the numbers of hospitalisations were 3195 and 1976, respectively. After the first 3 months, natural immunity was associated with a 95% lower risk of SARS-CoV-2 infection ( adjusted hazard ratio [ aHR ] 0·05 [ 95% CI 0·05–0·05 ] p < 0·001) and an 87% ( 0·13 [ 0·11–0·16 ]; p < 0·001) lower risk of COVID-19 hospitalisation for up to 20 months of follow-up. During a mean follow-up of 52 days ( SD 38) in cohort 2, 639 individuals with one-dose hybrid immunity were registered with a SARS-CoV-2 reinfection, compared with 1662 individuals with natural immunity ( numbers of hospitalisations were eight and 113, respectively). One-dose hybrid immunity was associated with a 58% lower risk of SARS-CoV-2 reinfection ( aHR 0·42 [ 95% CI 0·38–0·47 ]; p < 0·001) than natural immunity up to the first 2 months, with evidence of attenuation thereafter up to 9 months ( p < 0·001) of follow-up. During a mean follow-up of 66 days ( SD 53) in cohort 3, 438 individuals with two-dose hybrid immunity were registered as having had a SARS-CoV-2 reinfection, compared with 808 individuals with natural immunity ( numbers of hospitalisations were six and 40, respectively). Two-dose hybrid immunity was associated with a 66% lower risk of SARS-CoV-2 reinfection ( aHR 0·34 [ 95% CI 0·31–0·39 ]; p < 0·001) than natural immunity, with no significant attenuation up to 9 months ( p=0·07). To prevent one reinfection in the natural immunity cohort during follow-up, 767 individuals needed to be vaccinated with two doses. Both one-dose ( HR adjusted for age and baseline date 0·06 [ 95% CI 0·03–0·12 ]; p < 0·001) and two-dose ( HR adjusted for age and baseline date 0·10 [ 0·04–0·22 ]; p < 0·001) hybrid immunity were associated with a lower risk of COVID-19 hospitalisation than natural immunity.
The risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals who have survived and recovered from a previous infection remained low for up to 20 months. Vaccination seemed to further decrease the risk of both outcomes for up to 9 months, although the differences in absolute numbers, especially in hospitalisations, were small. These findings suggest that if passports are used for societal restrictions, they should acknowledge either a previous infection or vaccination as proof of immunity, as opposed to vaccination only.
Evidence from clinical trials and real-world observational studies conclusively shows that vaccines against COVID-19 induce an immunity that effectively reduces the risk of SARS-CoV-2 infection1Polack FP Thomas SJ Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine.N Engl J Med. 2020; 383: 2603-2615Google Scholar, 2Baden LR El Sahly HM Essink B et al.Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine.N Engl J Med. 2021; 384: 403-416Google Scholar, 3Voysey M Clemens SAC Madhi SA et al.Safety and efficacy of the ChAdOx1 nCoV-19 vaccine ( AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.Lancet. 2021; 397: 99-111Google Scholar, 4Chemaitelly H Yassine HM Benslimane FM et al.mRNA-1273 COVID-19 vaccine effectiveness against the B.1.1.7 and B.1.351 variants and severe COVID-19 disease in Qatar.Nat Med. 2021; 27: 1614-1621Google Scholar, 5Lopez Bernal J Andrews N Gower C et al.Effectiveness of COVID-19 vaccines against the B.1.617.2 ( delta) variant.N Engl J Med. 2021; 385: 585-594Google Scholar, 6Nordström P Ballin M Nordström A Effectiveness of heterologous ChAdOx1 nCoV-19 and mRNA prime–boost vaccination against symptomatic COVID-19 infection in Sweden: a nationwide cohort study.Lancet Reg Health Eur. 2021; 11100249Google Scholar, 7Chung H He S Nasreen S et al.Effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 infection and severe COVID-19 outcomes in Ontario, Canada: test negative design study.BMJ. 2021; 374n1943Google Scholar and severe COVID-19 disease including hospitalisation and death.4Chemaitelly H Yassine HM Benslimane FM et al.mRNA-1273 COVID-19 vaccine effectiveness against the B.1.1.7 and B.1.351 variants and severe COVID-19 disease in Qatar.Nat Med. 2021; 27: 1614-1621Google Scholar, 7Chung H He S Nasreen S et al.Effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 infection and severe COVID-19 outcomes in Ontario, Canada: test negative design study.BMJ. 2021; 374n1943Google Scholar, 8Thomas SJ Moreira Jr, ED Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine through 6 months.N Engl J Med. 2021; 385: 1761-1773Google Scholar, 9El Sahly HM Baden LR Essink B et al.Efficacy of the mRNA-1273 SARS-CoV-2 vaccine at completion of blinded phase.N Engl J Med. 2021; 385: 1774-1785Google Scholar, 10Falsey AR Sobieszczyk ME Hirsch I et al.Phase 3 safety and efficacy of AZD1222 ( ChAdOx1 nCoV-19) COVID-19 vaccine.N Engl J Med. 2021; 385: 2348-2360Google Scholar, 11Haas EJ Angulo FJ McLaughlin JM et al.Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data.Lancet. 2021; 397: 1819-1829Google Scholar, 12Hyams C Marlow R Maseko Z et al.Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 COVID-19 vaccination at preventing hospitalisations in people aged at least 80 years: a test-negative, case-control study.Lancet Infect Dis. 2021; 21: 1539-1548Google Scholar Research also shows that individuals who have recovered from an infection can develop naturally acquired immunity, which seems to be at least as protective as vaccine-induced immunity.13Petráš M Highly effective naturally acquired protection against COVID-19 persists for at least 1 year: a meta-analysis.J Am Med Dir Assoc. 2021; 22: 2263-2265Google Scholar Although some countries acknowledge a recent documented infection as sufficient proof of immunity, others do not unless the natural immunity has been supplemented by vaccination,14Block J Vaccinating people who have had COVID-19: why doesn't natural immunity count in the US?.BMJ. 2021; 374n2101Google Scholar so-called hybrid immunity. In general, national health-care authorities and government institutions recommend that individuals who have recovered from an infection should receive primary series and booster vaccination.15US Centers for Disease Control and PreventionInterim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the United States.https: //www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.htmlDate: Feb 22, 2022Date accessed: January 3, 2022Google Scholar There are several lines of evidence underpinning these recommendations and regulations. For example, not all individuals develop detectable concentrations of antibodies following a SARS-CoV-2 infection, especially if the infection is asymptomatic.16Wei J Matthews PC Stoesser N et al.Anti-spike antibody response to natural SARS-CoV-2 infection in the general population.Nat Commun. 2021; 126250Google Scholar Research also indicates a vaccine-induced immune response in individuals with a documented previous infection,17Goel RR Painter MM Apostolidis SA et al.mRNA vaccines induce durable immune memory to SARS-CoV-2 and variants of concern.Science. 2021; 374abm0829Google Scholar suggesting that vaccines in people with natural immunity provide additional benefits, with some support also from published18Abu-Raddad LJ Chemaitelly H Ayoub HH et al.Association of prior SARS-CoV-2 infection with risk of breakthrough infection following mRNA vaccination in Qatar.JAMA. 2021; 326: 1930-1939Google Scholar and preliminary data.19Goldberg Y Mandel M Bar-On YM et al.Protection and waning of natural and hybrid COVID-19 immunity.medRxiv. 2021; ( published online Dec 5.) ( preprint).https: //doi.org/10.1101/2021.12.04.21267114Google Scholar Yet, the strongest argument for the immunisation of people with natural immunity is the scarcity of studies investigating the long-term protection from natural immunity and its protection against severe disease, hospitalisation, and death.13Petráš M Highly effective naturally acquired protection against COVID-19 persists for at least 1 year: a meta-analysis.J Am Med Dir Assoc. 2021; 22: 2263-2265Google Scholar, 15US Centers for Disease Control and PreventionInterim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the United States.https: //www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.htmlDate: Feb 22, 2022Date accessed: January 3, 2022Google Scholar, 18Abu-Raddad LJ Chemaitelly H Ayoub HH et al.Association of prior SARS-CoV-2 infection with risk of breakthrough infection following mRNA vaccination in Qatar.JAMA. 2021; 326: 1930-1939Google Scholar, 20Chemaitelly H Bertollini R Abu-Raddad LJ Efficacy of natural immunity against SARS-CoV-2 reinfection with the beta variant.N Engl J Med. 2021; 385: 2585-2586Google Scholar, 21Kojima N Klausner JD Protective immunity after recovery from SARS-CoV-2 infection.Lancet Infect Dis. 2022; 22: 12-14Google Scholar
Research in contextEvidence before this studyWe did not do a formal literature search; however, we searched standard databases such as PubMed, and used search engines such as Google, to identify relevant literature until Jan 4, 2022, using the key words ” natural immunity ”, ” hybrid immunity ”, ” immunity ”, ” infection ”, ” vaccination ”, ” SARS-CoV-2, ” and ” COVID-19 ”. A meta-analysis of 15 cohort studies published on Sept 15, 2021, showed that naturally acquired immunity following recovery from a SARS-CoV-2 infection was associated with an 87% reduced risk of reinfection for up to 1 year. Yet, most national health-care authorities and government institutions recommend that individuals who have recovered from a documented previous infection should also be vaccinated. One reason for this might be evidence suggesting enhanced immunogenicity from vaccination in people with natural immunity, resulting in what is known as hybrid immunity. However, the primary reason for vaccinating people with natural immunity is probably the scarcity of evidence of the long-term protection against reinfection beyond 1 year.Added value of this studyThis registry-based study based on the total population of Sweden showed that natural immunity was associated with a 95% lower risk of SARS-CoV-2 reinfection and an 87% lower risk of COVID-19 hospitalisation than no immunity, for up to 20 months. In head-to-head comparisons, hybrid immunity induced by either one or two doses of a COVID-19 vaccine was associated with an additional risk reduction of SARS-CoV-2 reinfection compared with natural immunity for up to 9 months, although with small absolute differences. Furthermore, one-dose hybrid immunity was associated with an additional 94% lower risk of COVID-19 hospitalisation, and two-dose hybrid immunity with an additional 90% lower risk of COVID-19 hospitalisation, than natural immunity, although the number of hospitalisations were few.Implications of all the available evidenceThe risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation is low in individuals with a previous infection. Vaccination after recovering from a previous infection might result in additional risk reduction against reinfection and hospitalisation for up to 9 months, but the differences in absolute risk appear small. In relation to determining proof of immunity, distinguishing between immune and non-immune individuals could be more appropriate than the frequently used terminology of vaccinated and unvaccinated.
We did not do a formal literature search; however, we searched standard databases such as PubMed, and used search engines such as Google, to identify relevant literature until Jan 4, 2022, using the key words ” natural immunity ”, ” hybrid immunity ”, ” immunity ”, ” infection ”, ” vaccination ”, ” SARS-CoV-2, ” and ” COVID-19 ”. A meta-analysis of 15 cohort studies published on Sept 15, 2021, showed that naturally acquired immunity following recovery from a SARS-CoV-2 infection was associated with an 87% reduced risk of reinfection for up to 1 year. Yet, most national health-care authorities and government institutions recommend that individuals who have recovered from a documented previous infection should also be vaccinated. One reason for this might be evidence suggesting enhanced immunogenicity from vaccination in people with natural immunity, resulting in what is known as hybrid immunity. However, the primary reason for vaccinating people with natural immunity is probably the scarcity of evidence of the long-term protection against reinfection beyond 1 year.
This registry-based study based on the total population of Sweden showed that natural immunity was associated with a 95% lower risk of SARS-CoV-2 reinfection and an 87% lower risk of COVID-19 hospitalisation than no immunity, for up to 20 months. In head-to-head comparisons, hybrid immunity induced by either one or two doses of a COVID-19 vaccine was associated with an additional risk reduction of SARS-CoV-2 reinfection compared with natural immunity for up to 9 months, although with small absolute differences. Furthermore, one-dose hybrid immunity was associated with an additional 94% lower risk of COVID-19 hospitalisation, and two-dose hybrid immunity with an additional 90% lower risk of COVID-19 hospitalisation, than natural immunity, although the number of hospitalisations were few.
The risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation is low in individuals with a previous infection. Vaccination after recovering from a previous infection might result in additional risk reduction against reinfection and hospitalisation for up to 9 months, but the differences in absolute risk appear small. In relation to determining proof of immunity, distinguishing between immune and non-immune individuals could be more appropriate than the frequently used terminology of vaccinated and unvaccinated.
In this retrospective cohort study based on the total population of Sweden, we investigated the association between natural immunity and risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation for up to 20 months of follow-up. To investigate whether individuals with natural immunity would benefit further from vaccination, we also did head-to-head comparisons between people with hybrid immunity and people with natural immunity for up to 9 months of follow-up.
This retrospective cohort study was based on registry data covering the total population of Sweden. Vaccination in Sweden began on Dec 27, 2020, with older, frail individuals and individuals with specific comorbidities initially prioritised for vaccination.22Public Health Agency of SwedenRecommendations on order of priority of vaccination against COVID-19.https: //www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/vaccination-mot-covid-19/rekommendationer-for-vaccination-mot-covid-19/Date accessed: March 19, 2022Google Scholar For the specific time period and data underlying the present study, Sweden had three large pandemic waves: the first was from March to June, 2020; the second from October, 2020, to January, 2021; and the third from February to May, 2021. There was also a small wave that started in August, 2021.
Individuals considered for inclusion were all people who had received at least one dose of any vaccine up until May 26, 2021 ( N=3 640 421), and all individuals with a documented SARS-CoV-2 infection up until May 24, 2021 ( N=1 331 989). Data on individuals vaccinated against COVID-19, including the type of vaccine received, were collected from the Swedish Vaccination Register and data on documented SARS-CoV-2 infections were collected from the SmiNet register; both registers are managed by the Public Health Agency of Sweden.23Public Health Agency of SwedenNational Vaccination Register.https: //www.folkhalsomyndigheten.se/smittskydd-beredskap/vaccinationer/nationella-vaccinationsregistret/Date accessed: June 16, 2021Google Scholar, 24Public Health Agency of SwedenSmiNet.https: //www.folkhalsomyndigheten.se/smittskydd-beredskap/overvakning-och-rapportering/sminet/Date accessed: June 17, 2021Google Scholar All health-care providers in Sweden are obliged to report to these registers according to Swedish law, with an expected 100% coverage. For each of these individuals, we randomly sampled one individual from the general population using the Statistics Sweden database. Individuals were matched ( 1:1) on birth year, sex, and municipality, resulting in a total cohort of 5 833 003 unique individuals ( figure 1), from Sweden's total population of about 10·5 million individuals in June, 2021. This cohort was updated with respect to data on documented infections and vaccinations up to Oct 4, 2021. From this cohort, three study cohorts were formed. Cohort 1 was formed to compare natural immunity ( exposed) to no immunity ( unexposed). Here, all individuals with natural immunity with no previous vaccination ( N=1 028 640) were randomly matched pairwise on birth year and sex to an individual from the total cohort. The matched individual was required to be alive at baseline, uninfected and without previous infection, and unvaccinated, otherwise a new match was sought from the remaining total cohort. A total of 1 019 553 exposed individuals could be pairwise matched to unexposed individuals, resulting in a total cohort size of 2 039 106 individuals. Baseline date for both individuals within each pair was the date of the documented previous infection in the exposed individual. The second and third cohorts were formed to do head-to-head comparisons of one-dose and two-dose hybrid immunity ( exposed) versus natural immunity ( unexposed). All individuals with one-dose hybrid immunity ( N=763 213) or two-dose hybrid immunity ( N=712 806) were randomly matched pairwise to an individual from the total cohort with natural immunity ( N=1,028,640). Using the same principles for matching as in the first cohort, 481 159 matched pairs were identified in the second cohort ( N=962 318), and 283 905 matched pairs were identified in the third cohort ( N=567 810). Baseline date for both individuals within each pair in the second and third cohorts was the date of first dose of vaccine and second dose of vaccine in the exposed individual, respectively. The present study was approved by the Swedish Ethical Review Authority ( 495/2021), who waived the requirement of obtaining informed consent given the retrospective study design.Figure 1Selection of the cohortView Large Image Figure ViewerDownload Hi-res image Download ( PPT)
No immunity was defined as being unvaccinated and not having a documented previous SARS-CoV-2 infection at baseline. Natural immunity was defined as having a documented previous infection but being unvaccinated at baseline. One-dose hybrid immunity was defined as having a documented previous infection and having received a single dose of either ChAdOx1 nCoV-19 ( Oxford-AstraZeneca), BNT162b2 ( Pfizer-BioNTech), or mRNA-1273 ( Moderna) either before or after infection at baseline. Two-dose hybrid immunity was defined as having a documented previous infection and having received two doses of any of the vaccines at baseline, with at least the second dose given after the infection.
This study had two outcomes. The first outcome was SARS-CoV-2 infection as documented in the SmiNet register from March 20, 2020, until Oct 4, 2021. Given that all confirmed infections are documented in this register, this outcome was defined as a SARS-CoV-2 infection of any severity for the present study. The second outcome was inpatient hospitalisation with COVID-19 as the main diagnosis and reason for admission, traced using the National Inpatient Register and the International Classification of Disease ( ICD) version 10 code U071. This register is managed by the National Board of Health and Welfare. Hospitalisations in the cohorts could be tracked from March 30, 2020, until Sept 5, 2021. Only hospitalisations and infections that occurred more than 14 days after baseline were evaluated. Planned follow-up for assessment of outcomes was 20 months for cohort 1 and was 9 months for cohorts 2 and 3, and follow-up time in days was counted until the date of either a confirmed SARS-CoV-2 infection or COVID-19 hospitalisation, a vaccination after baseline ( for unvaccinated individuals and individuals with one-dose hybrid immunity), death, or end of possible follow-up time ( Oct 4, 2021, for the infection outcome and Sept 5, 2021, for the hospitalisation outcome), whichever occurred first.
Hazards over time for the outcome of SARS-CoV-2 infection based on immunity status were illustrated using proportional hazards models with 95% CIs and restricted cubic splines. The knots were placed in default position. To compare the risk of both outcomes ( SARS-CoV-2 infection and COVID-19 hospitalisation) on the basis of immunity status, Cox regression was used to calculate hazard ratios ( HR). To adjust for the matched samples, 95% CIs were estimated using robust standard errors by the variance–covariance matrix ( VCE) command and robust option in Stata. To formally test whether the associations were time dependent, Schoenfeld's residuals were evaluated using estat phtest command in Stata. Because the test indicated that the proportional hazard assumption was violated ( p < 0·05) for some of the main exposures, the associations were also evaluated in time intervals in the cohorts. In all cohorts, the first model was adjusted for age and baseline date, to account for variations in infection pressure during follow-up ( reported as HR). The second model included the additional covariates sex, homemaker service ( yes or no), education ( six categories), marital status ( five categories), whether the individual was born in Sweden or not, and nine diagnoses at baseline ( yes or no; reported as adjusted [ a ] HR). To investigate whether there was effect measure modification of the associations between the exposure and outcome by any of the covariates, interaction analyses were done using product terms created by multiplying the variable coding for immunity status at baseline by each respective covariate, which were added to the fully adjusted Cox model. Given that the interaction terms were significant ( p < 0·001) for many covariates, associations were investigated in subgroups according to these covariates, including type of vaccine for two-dose hybrid immunity compared with natural immunity. Other subgroup analyses were by age, sex, comorbidity status ( compared with the total population), and homemaker service ( compared with the total population).
The covariates were selected a priori on the basis of a previous study in a similar population.25Bergman J Ballin M Nordström A Nordström P Risk factors for COVID-19 diagnosis, hospitalization, and subsequent all-cause mortality in Sweden: a nationwide study.Eur J Epidemiol. 2021; 36: 287-298Google Scholar For the diagnoses of interest, the National Inpatient Register was used to obtain information about inpatient care since the beginning of 1998, and the National Outpatient Register was used to obtain information on outpatient specialist care since the beginning of 2001. Information about prescribed drugs of interest at baseline and death during follow up was obtained using the Prescribed Drug Register from the beginning of 2014 onwards and the Cause of Death Register, respectively, which is also managed by the National Board of Health and Welfare. Information about homemaker services ( ie, help from the community with housekeeping tasks that older people can no longer perform) was also obtained from the National Board of Health and Welfare. Birth year and month, country of birth, marital status, level of highest education, and sex for all individuals in the cohort was obtained from Statistics Sweden. Definitions of comorbidities are provided in appendix p 2.
All analyses were done using SPSS version 27.0 for Mac and Stata version 16·1 for Mac. A two-sided p-value of less than 0·05 or a HR with a 95% CI not crossing 1 was considered significant. In the two-dose hybrid immunity versus natural immunity cohort, the number needed to vaccinate to prevent one reinfection in individuals with natural immunity was estimated as the difference in event rate between the two groups, inverted.
There was no funding source for this study.
According to the SmiNet register, 94·4% of infections were confirmed using PCR, 4·8% through sequencing, and the remaining through a combination of methods. In cohort 1 ( natural immunity vs no immunity), the mean baseline date was Jan 1, 2021, and the median age was 39·2 years ( IQR 25·5–53·0; table 1). Individuals in cohort 2 ( one-dose hybrid immunity vs natural immunity) had a median age of 39·9 years ( 28·3–52·4) at baseline and the mean baseline date was June 7, 2021, more than 6 months later than the baseline date in cohort 1, with a lower resulting infection pressure during follow-up, since individuals in cohort 2 and 3 missed the first wave, and shorter follow-up time. Individuals in cohort 3 ( two-dose hybrid immunity vs natural immunity) had a median age of 37·6 years ( 27·8–50·3) with a baseline date of July 9, 2021. Individuals with natural immunity in the second and third cohorts were more often born outside of Sweden than those with natural immunity in the first cohort. Participant characteristics at different time intervals during follow-up in the cohorts are in the appendix ( pp 3–4).Table 1Baseline characteristics of the three study cohortsCohort 1 * Mean baseline date was Jan 1, 2021 ( range Jan 25, 2020, to Oct 3, 2021).Cohort 2†Mean baseline date was June 7, 2021 ( Dec 27, 2020, to Sept 27, 2021).Cohort 3‡Mean baseline date was July 9, 2021 ( Dec 30, 2020, to Oct 3, 2021).Natural immunity ( n=1 019 553) No immunity ( n=1 019 553) One-dose hybrid immunity ( n=481 159) Natural immunity ( n=481 159) Two-dose hybrid immunity ( n=283 905) Natural immunity ( n=283 905) Age, years39·2 ( 25·5–53·0) 39·2 ( 25·5–53·0) 39·9 ( 28·3–52·4) 39·9 ( 28·3–52·4) 37·6 ( 27·8–50·3) 37·6 ( 27·8–50·3) SexFemale518 515 ( 50·9%) 538 766 ( 52·8%) 249 461 ( 51·8%) 236 717 ( 49·2%) 155 634 ( 54·8%) 142 285 ( 50·1%) Male501 038 ( 49·1%) 480 787 ( 47·2%) 231 698 ( 48·2%) 244 442 ( 50·8%) 128 271 ( 45·2%) 141 620 ( 49·9%) Homemaker service recipient§Homemaker services include domestic services provided to individuals ( primarily older individuals) who live at home but need help with shopping, cleaning, meal preparation, and similar tasks. COPD=chronic obstructive pulmonary disease.29 381 ( 2·9%) 17 582 ( 1·7%) 9918 ( 2·1%) 7160 ( 1·5%) 7881 ( 2·8%) 5026 ( 1·8%) Born in Sweden783 373 ( 76·8%) 784 810 ( 77·0%) 385 140 ( 80·0%) 342 936 ( 71·3%) 226 898 ( 79·9%) 184 893 ( 65·1%) Marital statusMarried366 339 ( 35·9%) 343 165 ( 33·7%) 184 948 ( 38·4%) 182 237 ( 37·9%) 101 445 ( 35·7%) 100 150 ( 35·3%) Not married526 479 ( 51·6%) 550 797 ( 54·0%) 245 855 ( 51·1%) 241 689 ( 50·2%) 153 522 ( 54·1%) 148 319 ( 52·2%) Divorced92 143 ( 9·0%) 96 537 ( 9·5%) 39 973 ( 8·3%) 45 249 ( 9·4%) 22 323 ( 7·9%) 27 293 ( 9·7%) Widow or widower21 481 ( 2·1%) 24 578 ( 2·4%) 7715 ( 1·6%) 7797 ( 1·6%) 5013 ( 1·8%) 4995 ( 1·8%) Other13 111 ( 1·3%) 4 476 ( 0·4%) 171 ( < 0·1%) 124 ( < 0·1%) 1602 ( 0·6%) 3148 ( 1·1%) EducationElementary school for < 9 years40 311 ( 4·0%) 42 264 ( 4·1%) 14 197 ( 3·0%) 20 180 ( 4·2%) 8402 ( 3·0%) 13 902 ( 4·9%) Elementary school for 9 years111 606 ( 10·9%) 121 185 ( 11·9%) 55 717 ( 11·6%) 64 194 ( 13·3%) 31 578 ( 11·1%) 40 430 ( 14·2%) Secondary school for 2 years153 336 ( 15·0%) 152 925 ( 15·0%) 68 252 ( 14·2%) 76 798 ( 16·0%) 37 324 ( 13·1%) 44 952 ( 15·8%) Secondary school for > 2 years243 207 ( 23·9%) 226 828 ( 22·2%) 125 153 ( 26·0%) 126 711 ( 26·3%) 77 835 ( 27·4%) 78 572 ( 28·7%) University355 077 ( 34·8%) 350 063 ( 34·3%) 192 321 ( 40·0%) 163 866 ( 34·1%) 114 261 ( 40·2%) 87 778 ( 30·9%) Unknown116 016 ( 11·4%) 126 288 ( 12·4%) 25 519 ( 5·3%) 29 410 ( 6·1%) 14 505 ( 5·1%) 18 281 ( 6·4%) ComorbiditiesMyocardial infarction11 213 ( 1·1%) 10 190 ( 1·0%) 4358 ( 0·9%) 4342 ( 0·9%) 2371 ( 0·8%) 2433 ( 0·9%) Stroke11 775 ( 1·2%) 9 233 ( 0·9%) 4522 ( 0·9%) 3659 ( 0·8%) 2953 ( 1·0%) 2203 ( 0·8%) Diabetes46 234 ( 4·5%) 51 901 ( 5·1%) 25 365 ( 5·3%) 20 994 ( 4·4%) 15 078 ( 5·3%) 12 242 ( 4·3%) Hypertension141 376 ( 13·9%) 145 880 ( 14·3%) 68 487 ( 14·2%) 58 712 ( 12·2%) 37 800 ( 13·3%) 32 299 ( 11·4%) Kidney failure9614 ( 0·9%) 7950 ( 0·8%) 4155 ( 0·9%) 3458 ( 0·7%) 2531 ( 0·9%) 2181 ( 0·8%) COPD8056 ( 0·8%) 6642 ( 0·7%) 3098 ( 0·6%) 3942 ( 0·8%) 1779 ( 0·6%) 1809 ( 0·6%) Asthma67 440 ( 6·6%) 65 240 ( 6·4%) 31 538 ( 6·6%) 27 803 ( 5·8%) 19 215 ( 6·8%) 16 218 ( 5·7%) Depression150 177 ( 14·7%) 159 270 ( 15·6%) 79 151 ( 16·5%) 74 956 ( 15·6%) 49 747 ( 17·5%) 45 273 ( 15·9%) Cancer24 838 ( 2·4%) 24 662 ( 2·4%) 10 703 ( 2·2%) 9932 ( 2·1%) 6036 ( 2·1%) 5480 ( 1·9%) Data are n (%) or median ( IQR). * Mean baseline date was Jan 1, 2021 ( range Jan 25, 2020, to Oct 3, 2021).† Mean baseline date was June 7, 2021 ( Dec 27, 2020, to Sept 27, 2021).‡ Mean baseline date was July 9, 2021 ( Dec 30, 2020, to Oct 3, 2021).§ Homemaker services include domestic services provided to individuals ( primarily older individuals) who live at home but need help with shopping, cleaning, meal preparation, and similar tasks. COPD=chronic obstructive pulmonary disease. Open table in a new tab
Data are n (%) or median ( IQR).
The number of confirmed SARS-CoV-2 infections in Sweden during follow-up, and SARS-CoV-2 variants sequenced in Sweden during the study period, are shown in the appendix ( pp 5, 8). During the study period there were three large waves of COVID-19. The first two waves ( in March–June, 2020, and October, 2020, to January, 2021) occurred before the sequencing data were available, and before the alpha variant became dominant in Sweden. Based on the sequencing data, the alpha variant dominated during the third wave ( in February–May, 2021) and the delta variant dominated from July, 2021, onwards ( thus including the fourth wave that started in August, 2021).
During a mean follow-up of 164 days ( SD 100), 34 090 individuals with natural immunity were registered as having had a SARS-CoV-2 reinfection compared with 99 168 infections in non-immune individuals. Compared with no immunity, natural immunity was associated with a gradually reduced risk of reinfection during the first 3 months of follow-up ( figure 2A). After 3 months, the associated risk reduction was 95% ( aHR 0·05 [ 95% CI 0·05–0·05 ]; p < 0·001), with no signs of attenuation for up to 20 months of follow-up ( figure 2A; table 2). The associations appeared to attenuate with increasing age ( table 2), in people born outside Sweden ( data not shown), with increasing education level ( data not shown), and in people receiving a homemaker service ( table 2; p < 0·001 for all).Figure 2Risk of SARS-CoV-2 infection in individuals with natural immunity compared with individuals without immunity ( A), and risk of these outcomes in individuals with one-dose hybrid immunity ( B) and two-dose hybrid immunity ( C) compared with individuals with natural immunityShow full captionThe associations were modelled using restricted cubic splines in default positions. The shaded areas show the 95% CI for the hazard ratios. The associations were adjusted for age, baseline date, sex, marital status, homemaker service, place of birth, education, and comorbidities according to table 1.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) Table 2Risk of SARS-CoV-2 infection for individuals with natural immunity compared with individuals with no immunityNatural immunity ( n=1 019 553) No immunity ( n=1 019 553) Hazard ratio ( 95% CI) Number of eventsIR per 100 000 person-daysNumber of eventsIR per 100 000 person-daysAdjusted for age and baseline dateFully adjusted * Adjusted for age, baseline date, sex, marital status, homemaker service, place of birth, education, and comorbidities according to table 1.Follow-up time in total cohort14 days to 3 months ( n=2 039 106) 31 27217·954 36834·20·54 ( 0·53–0·55) 0·52 ( 0·52–0·53) 3–6 months ( n=1 477 887) 18141·433 01429·30·05 ( 0·05–0·05) 0·04 ( 0·04–0·05) 6–9 months ( n=783 767) 7000·775888·90·08 ( 0·08–0·09) 0·08 ( 0·07–0·09) ≥9 months ( n=303 236) 3040·641988·50·07 ( 0·06–0·08) 0·07 ( 0·06–0·08) ≥3 months ( n=1 477 887) 28181·744 80031·20·06 ( 0·05–0·06) 0·05 ( 0·05–0·05) Events after ≥3 months follow-up, by sexMale ( n=722 657) 11511·422 79032·90·05 ( 0·04–0·05) 0·04 ( 0·04–0·04) Female ( n=755 230) 16672·022 01029·60·07 ( 0·06–0·07) 0·06 ( 0·06–0·07) Events after ≥3 months follow-up, by age < 50 years ( n=1 102 189) 20701·637 77535·30·05 ( 0·05–0·06) 0·04 ( 0·04–0·05) 50–64 years ( n=274 315) 5472·0613923·40·08 ( 0·08–0·09) 0·08 ( 0·07–0·09) 65–79 years ( n=74 090) 1031·55637·80·20 ( 0·16–0·25) 0·18 ( 0·15–0·23) ≥80 years ( n=27 305) 984·33238·40·55 ( 0·44–0·70) 0·42 ( 0·33–0·53) Events after ≥3 months follow-up in those receiving homemaker service ( N=19 324) †Comparison is with the total population.1044·325812·90·33 ( 0·26–0·41) 0·32 ( 0·25–0·40) Events after ≥3 months follow-up in those with any comorbidity ( n=441 752) †Comparison is with the total population.9742·111 55126·90·08 ( 0·07–0·08) 0·07 ( 0·07–0·08) In each matched pair, the baseline date for both individuals was set as the date of the first documented previous infection in the individual with natural immunity. Outcome events were traced from 14 days after baseline until a maximum follow-up of 613 days ( mean 164 days [ SD 100 ]). IR=incidence rate. * Adjusted for age, baseline date, sex, marital status, homemaker service, place of birth, education, and comorbidities according to table 1.† Comparison is with the total population. Open table in a new tab
The associations were modelled using restricted cubic splines in default positions. The shaded areas show the 95% CI for the hazard ratios. The associations were adjusted for age, baseline date, sex, marital status, homemaker service, place of birth, education, and comorbidities according to table 1.
In each matched pair, the baseline date for both individuals was set as the date of the first documented previous infection in the individual with natural immunity. Outcome events were traced from 14 days after baseline until a maximum follow-up of 613 days ( mean 164 days [ SD 100 ]). IR=incidence rate.
For the outcome of COVID-19 hospitalisation ( table 3), 3195 people with natural immunity were hospitalised and 1976 people with no natural immunity were hospitalised; natural immunity was associated with increased risk during the first 3 months of follow-up, but from 3 months onwards there was an associated 87% lower risk of COVID-19 hospitalisation in people with natural immunity than in people with no immunity ( aHR 0·13, 95% CI 0·11–0·16, p < 0·001) for up to 19 months of follow-up. The associations were weaker with increasing age and in individuals receiving a homemaker service ( both p < 0·001).Table 3Risk of COVID-19 hospitalisation for individuals with natural immunity compared with individuals with no immunityNatural immunity ( n=1 018 636) No immunity ( n=1 018 636) Hazard ratio ( 95% CI) Number of eventsIR per 100 000 person-daysNumber of eventsIR per 100 000 person-daysAdjusted for age and baseline dateFully adjusted * Adjusted for age, baseline date, sex, marital status, homemaker service, place of birth, education, and comorbidities according to table 1.Follow-up time in total cohort14 days to 3 months ( n=2 037 272) 30653·610301·33·21 ( 2·98–3·45) 3·02 ( 2·80–3·26) 3–6 months ( n=1 546 582) 770·066320·530·12 ( 0·09–0·15) 0·11 ( 0·09–0·14) 6–9 months ( n=773 806) 280·031900·210·18 ( 0·12–0·26) 0·15 ( 0·10–0·22) ≥9 months ( N=260 984) 250·061240·270·28 ( 0·18–0·42) 0·22 ( 0·15–0·34) ≥3 months ( n=1 546 582) 1300·089460·630·14 ( 0·12–0·17) 0·13 ( 0·11–0·16) Events after ≥3 months follow-up, by sexMale ( n=756 942) 800·105480·750·15 ( 0·12–0·19) 0·14 ( 0·11–0·17) Female ( n=789 640) 500·063980·510·13 ( 0·10–0·18) 0·12 ( 0·09–0·16) Events after ≥3 months follow-up, by age < 50 years ( N=1 160 812) 270·024200·370·06 ( 0·04–0·09) 0·06 ( 0·04–0·09) 50–64 years ( n=283 569) 460·173381·30·13 ( 0·10–0·18) 0·12 ( 0·09–0·17) 65–79 years ( n=74 643) 430·65921·30·50 ( 0·35–0·71) 0·43 ( 0·29–0·63) ≥80 years ( n=27 558) 140·62962·50·25 ( 0·14–0·45) 0·17 ( 0·10–0·31) Events after ≥3 months follow-up in those receiving homemaker service ( n=19 626) †Comparison is with the total population. IR=incidence rate.271·0773·50·26 ( 0·16–0·43) 0·22 ( 0·13–0·36) Events after ≥3 months follow-up in those with any comorbidity ( n=459 097) †Comparison is with the total population. IR=incidence rate.870·196151·20·18 ( 0·17–0·93) 0·16 ( 0·13–0·20) In each matched pair, the baseline date for both individuals was set as the date of the first documented previous infection in the individual with natural immunity. Outcome events were traced from 14 days after baseline until a maximum follow-up of 588 days ( mean 165 days [ SD 95 ]). * Adjusted for age, baseline date, sex, marital status, homemaker service, place of birth, education, and comorbidities according to table 1.† Comparison is with the total population. IR=incidence rate. Open table in a new tab
In each matched pair, the baseline date for both individuals was set as the date of the first documented previous infection in the individual with natural immunity. Outcome events were traced from 14 days after baseline until a maximum follow-up of 588 days ( mean 165 days [ SD 95 ]).
During a mean follow-up of 52 days ( SD 38), 639 individuals with one-dose hybrid immunity were registered with a SARS-CoV-2 reinfection, compared with 1662 individuals with natural immunity ( appendix p 6). The associations attenuated with increasing follow-up time ( figure 2B, p < 0·001). Thus, during the first 2 months of follow-up, compared with natural immunity, one-dose hybrid immunity was associated with a 58% lower risk of reinfection ( aHR 0·42 [ 95% CI 0·38–0·47 ]; p < 0·001), which was reduced to 45% ( 0·55 [ 0·39–0·76 ]; p < 0·001) from 2 months onwards. Overall, the associations were weaker in older individuals, in individuals with homemaker service ( p < 0·001), and in individuals with comorbidities ( p < 0·001; appendix p 6). With respect to COVID-19 hospitalisations, eight individuals were hospitalised among individuals with one-dose hybrid immunity ( incidence rate [ IR ] 0·04) compared with 113 individuals with natural immunity ( IR 0·56; HR 0·06 [ 95% CI 0·03–0·12 ]; p < 0·001).
During a mean follow-up of 66 days ( SD 53), 438 individuals with two-dose hybrid immunity were registered as having had a SARS-CoV-2 reinfection, compared with 808 individuals with natural immunity ( appendix p 7). Correspondingly, the number of individuals with natural immunity needed to be double vaccinated to prevent one reinfection during follow-up was 767. Overall, two-dose hybrid immunity was associated with a 66% lower risk of reinfection than natural immunity ( aHR 0·34 [ 95% CI 0·31–0·39 ]; p < 0·001). During the first 2 months of follow-up, two-dose hybrid immunity was associated with a 69% ( 0·31 [ 0·26–0·36 ]; p < 0·001) lower risk of reinfection than natural immunity. From 2 months onwards, the associated risk reduction was 56% ( 0·44 [ 0·35–0·56 ]; p < 0·001), with no significant attenuation up to 9 months ( p=0·07; figure 2C). Overall, the associations were slightly weaker in older individuals, in individuals with homemaker service ( p < 0·001), and in individuals with comorbidities ( p < 0·001; ( appendix p 7). With respect to vaccine types, a significant association was observed for mRNA vaccines ( aHR 0·32 [ 95% CI 0·28–0·37 ]; p < 0·001) but not ChAdOx1 nCoV-19 ( 0·75 [ 0·41–1·37 ]; p=0·35; appendix p 7).
With respect to COVID-19 hospitalisations, six individuals with two-dose hybrid immunity were hospitalised ( IR 0·04) compared with 40 individuals with natural immunity ( IR 0·44; HR 0·10 [ 95% CI 0·04–0·22 ]; p < 0·001).
In this nationwide study, immunity acquired from a previous infection was associated with a low risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation for up to 20 months. In head-to-head comparisons, immunity acquired from a previous infection plus either one or two doses of a COVID-19 vaccine was associated with a greater reduced risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation for up to 9 months than previous infection only, although with small differences in absolute numbers during follow-up.
Many authorities recommend that all individuals should receive both primary series vaccination and booster vaccination irrespective of whether they have previously been infected. The strongest argument behind this recommendation might be the scarcity of evidence on long-term protection from natural immunity. A meta-analysis of 15 observational studies showed that natural immunity was associated with an 87% lower risk of reinfection than non-immunity for up to 1 year.13Petráš M Highly effective naturally acquired protection against COVID-19 persists for at least 1 year: a meta-analysis.J Am Med Dir Assoc. 2021; 22: 2263-2265Google Scholar Our study extends the body of evidence with up to 20 months of follow-up and more than 130 000 documented SARS-CoV-2 infections, and our results showed that individuals with natural immunity had an associated 95% protection against SARS-CoV-2 reinfection during follow-up ( from 3 months after initial infection until 20 months), with no signs of waning. These results indicate that natural immunity might be better maintained than immunity induced by vaccination only, as suggested also by preliminary data from an Israeli study.19Goldberg Y Mandel M Bar-On YM et al.Protection and waning of natural and hybrid COVID-19 immunity.medRxiv. 2021; ( published online Dec 5.) ( preprint).https: //doi.org/10.1101/2021.12.04.21267114Google Scholar In further support of our findings, we recently reported waning vaccine effectiveness against SARS-CoV-2 infection within a few months in a similar study based on the total population of Sweden.26Nordström P Ballin M Nordström A Risk of infection, hospitalisation, and death up to 9 months after a second dose of COVID-19 vaccine: a retrospective, total population cohort study in Sweden.Lancet. 2022; 399: 814-823Google Scholar Another important finding of the present study is the association between natural immunity and later hospitalisation for a reinfection, which has not previously been reported in the literature. As expected, there was an increased risk of hospitalisation during the first 3 months after the first infection, but for those who survived, natural immunity was associated with 87% protection against COVID-19 hospitalisation during the rest of follow-up. The associated level of protection remained high ( 78%) even from 9 up to 19 months of follow-up, altogether indicating long-lasting protection, including against severe disease, from natural immunity. Together, these findings might suggest that any passports or documents used to identify whether a person is immune or not, and used for societal restrictions, should acknowledge either a previous infection or vaccination as proof of immunity, as opposed to vaccination only. This policy could have social and equity implications, especially for individuals in countries with low vaccine coverage, considering also that the dominant omicron variant is less sensitive to current vaccines than previous variants.27UK Health Security AgencyCOVID-19 vaccine surveillance report: week 4.https: //assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment data/file/1050721/Vaccine-surveillance-report-week-4.pdfDate: Jan 27, 2022Date accessed: January 28, 2022Google Scholar
The associated protection from natural immunity was lower in older individuals and in individuals receiving a homemaker service, as previously reported in a nationwide study from Denmark.28Hansen CH Michlmayr D Gubbels SM Mølbak K Ethelberg S Assessment of protection against reinfection with SARS-CoV-2 among 4 million PCR-tested individuals in Denmark in 2020: a population-level observational study.Lancet. 2021; 397: 1204-1212Google Scholar Because these individuals have higher risk of critical illness and death from COVID-19,24Public Health Agency of SwedenSmiNet.https: //www.folkhalsomyndigheten.se/smittskydd-beredskap/overvakning-och-rapportering/sminet/Date accessed: June 17, 2021Google Scholar, 29Ballin M Bergman J Kivipelto M Nordström A Nordström P Excess mortality after COVID-19 in Swedish long-term care facilities.J Am Med Dir Assoc. 2021; 22 ( 80.e8): 1574Google Scholar boosting their level of protection is important. Thus, as further shown through head-to-head comparisons, individuals who had recovered from a previous infection had an additional associated protection against SARS-CoV-2 reinfection if they had also been vaccinated, although the associations appeared slightly weaker in older individuals. The associated benefit seemed slightly stronger and more stable for those given two doses rather than one dose of vaccine, and it was more clearly detectable among those vaccinated with mRNA vaccines than ChAdOx1 nCoV-19 ( in whom the association was weaker and not significant, although the number of participants contributing to this analysis was small). This finding is supported by a systematic review and meta-regression of vaccine effectiveness studies, which suggested faster waning of immunity with ChAdOx1 nCoV-19 than with BNT162b2.30Feikin D Higdon MM Abu-Raddad LJ et al.Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression.Lancet. 2022; 399: 924-944Google Scholar In the present study, there was also evidence of waning protection, especially for those with one-dose hybrid immunity. Waning protection from hybrid immunity was observed also in a recent Israeli preprint study of 5·7 million individuals.19Goldberg Y Mandel M Bar-On YM et al.Protection and waning of natural and hybrid COVID-19 immunity.medRxiv. 2021; ( published online Dec 5.) ( preprint).https: //doi.org/10.1101/2021.12.04.21267114Google Scholar Additionally, the absolute risk reduction associated with hybrid immunity in the present study was small, indicating that to prevent one SARS-CoV-2 reinfection among those with natural immunity, 767 individuals would need to be vaccinated with two doses. Similar results were reported in an Israeli preprint study including 14 029 matched pairs,31Gazit S Shlezinger R Perez G et al.Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections.medRxiv. 2021; ( published online Aug 25, 2021.) ( preprint).https: //doi.org/10.1101/2021.08.24.21262415Google Scholar in which one additional dose of vaccine in those with natural immunity was associated with seven fewer cases of symptomatic reinfection, suggesting that about 2000 individuals needed to be vaccinated to prevent one reinfection. If these associations are causal, the overall clinical relevance of these effects appears uncertain. In the present study, both one-dose and two-dose hybrid immunity were associated with protection against COVID-19 hospitalisation that was above the level of protection afforded by natural immunity. Because the primary aim of COVID-19 vaccination is to prevent severe disease, this finding is important. However, hospitalisations were rare, and because these analyses were based on a small number of cases, further studies should seek to assess the duration of protection of hybrid immunity against severe COVID-19.
This study has limitations that should be considered. First, the observational nature of the study limits the possibility to draw causal inferences, and there might be unknown confounding or bias not accounted for. For example, there is a risk of selection bias in individuals without a previous infection because they might be less inclined to take a PCR test than individuals with a documented previous infection, although this bias would not affect the estimates for the outcome of COVID-19 hospitalisation. Furthermore, as individuals with a previous infection were censored upon vaccination, the remaining cohort might have become less representative as time passed, introducing another selection bias. Although the associations were stable after adjustment for a rather rich set of covariates, the possibility of unmeasured confounding or bias remains. Moreover, in the analysis of hybrid immunity versus natural immunity, it is possible that vaccinated individuals with symptoms of infection are more prone to self-testing than individuals that remain unvaccinated after a documented infection. If so, this behaviour would attenuate the associations for the outcome of infection; however, it would not affect the associations with hospitalisation. Second, mean baseline date was not the same in all cohorts, which could mean that variations in infection pressure and dominating SARS-CoV-2 variants during follow-up influenced the results, although we adjusted all models for baseline date. Third, we could not evaluate how different variants of SARS-CoV-2 influenced the associations, as we did not have access to such data on an individual level. Fourth, although individuals with a documented previous infection were excluded from the non-immune cohort, individuals with a previous asymptomatic infection might still have been included. Similarly, there is a risk of misclassification bias ( ie, false-positive and false-negative tests, which could potentially result in underestimated associated benefits of natural immunity vs no immunity). However, the PCR test has been estimated to have a 97·1% sensitivity and 99·9% specificilty.32Lorentzen HF Schmidt SA Sandholdt H Benfield T Estimation of the diagnostic accuracy of real-time reverse transcription quantitative polymerase chain reaction for SARS-CoV-2 using re-analysis of published data.Dan Med J. 2020; 67: 67Google Scholar Fifth, it can not be determined to what extent the results apply to the omicron variant. However, a study found that previous infection was associated with about 60% protection against symptomatic reinfection and about 90% protection against severe reinfection ( hospitalisation or death) with the omicron variant.33Altarawneh H Chemaitelly H Tang P et al.Protection against the omicron variant from previous SARS-CoV-2 infection.N Engl J Med. 2022; ( published online Feb 22.) https: //doi.org/10.1056/NEJMc2200133Google Scholar
Strengths of the present study include the use of registers with 100% nationwide coverage and a follow-up time up of 20 months for the exposure of natural immunity and up to 9 months for hybrid immunity. Another strength is the head-to-head comparisons of hybrid immunity versus natural immunity, in which individuals in each pair were matched on birth year, had similar baseline characteristics, and started follow-up on the same date, and in which several covariates were adjusted for. Together, these methods reduce the risk of confounding when the aim is to perform direct comparisons. Finally, the large, population-based sample size increases the generalisability of the results to other countries with similar population structures.
This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on April 8, 2022
This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on April 8, 2022
All authors conceived and designed the study. PN acquired the data and did the statistical analyses. PN and MB accessed and verified the underlying data and drafted the manuscript. PN and AN supervised the work. All authors interpreted the data, critically revised the manuscript for intellectual content, gave final approval of the version to be published, had full access to all the data, and had final responsibility for the decision to submit for publication.
The data files used for the present study are publicly unavailable according to regulations under Swedish law. However, access to all the data used for the present study can be requested from the National Board of Health and Welfare, Statistics Sweden, and the Public Health Agency of Sweden.
We declare no competing interests.
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Interplay of infection and vaccination in long-term protection from COVID-19The SARS-CoV-2 omicron variant has rapidly spread throughout the world, including in countries with high vaccination rates. As populations increasingly include individuals with both vaccination-driven and infection-driven immunity, it becomes important to understand the differential protection associated with diverse immune histories. Although studies assessing long-term immunity after omicron infection are not yet possible, population-wide studies done in the context of previous variants of concern can be highly informative. Full-Text PDF Correction to Lancet Infect Dis 2022; published online March 31. https: //doi.org/10.1016/S1473-3099 ( 22) 00143-8Nordström P, Ballin M, Nordström A. Risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals with natural and hybrid immunity: a retrospective, total population cohort study in Sweden. Lancet Infect Dis 2022; published online March 31. https: //doi.org/10.1016/S1473-3099 ( 22) 0014—In this Article, the first line of the Findings, in the Summary, should have read ‘ Cohort 1 was comprised of 2 039 106 individuals, cohort 2 of 962 318 individuals, and cohort 3 of 567 810 individuals’. Full-Text PDF | tech |
Effectiveness of CoronaVac, ChAdOx1 nCoV-19, BNT162b2, and Ad26.COV2.S among individuals with previous SARS-CoV-2 infection in Brazil: a test-negative, case-control study - The Lancet Infectious Diseases | BackgroundCOVID-19 vaccines have proven highly effective among individuals without a previous SARS-CoV-2 infection, but their effectiveness in preventing symptomatic infection and severe outcomes among individuals with previous infection is less clear. We aimed to estimate the effectiveness of four COVID-19 vaccines against symptomatic infection, hospitalisation, and death for individuals with laboratory-confirmed previous SARS-CoV-2 infection.MethodsUsing national COVID-19 notification, hospitalisation, and vaccination datasets from Brazil, we did a test-negative, case-control study to assess the effectiveness of four vaccines ( CoronaVac [ Sinovac ], ChAdOx1 nCoV-19 [ AstraZeneca ], Ad26.COV2.S [ Janssen ], and BNT162b2 [ Pfizer-BioNtech ]) for individuals with laboratory-confirmed previous SARS-CoV-2 infection. We matched cases with RT-PCR positive, symptomatic COVID-19 with up to ten controls with negative RT-PCR tests who presented with symptomatic illnesses, restricting both groups to tests done at least 90 days after an initial infection. We used multivariable conditional logistic regression to compare the odds of test positivity and the odds of hospitalisation or death due to COVID-19, according to vaccination status and time since first or second dose of vaccines.FindingsBetween Feb 24, 2020, and Nov 11, 2021, we identified 213 457 individuals who had a subsequent, symptomatic illness with RT-PCR testing done at least 90 days after their initial SARS-CoV-2 infection and after the vaccination programme started. Among these, 30 910 ( 14·5%) had a positive RT-PCR test consistent with reinfection, and we matched 22 566 of these cases with 145 055 negative RT-PCR tests from 68 426 individuals as controls. Among individuals with previous SARS-CoV-2 infection, vaccine effectiveness against symptomatic infection 14 or more days from vaccine series completion was 39·4% ( 95% CI 36·1–42·6) for CoronaVac, 56·0% ( 51·4–60·2) for ChAdOx1 nCoV-19, 44·0% ( 31·5–54·2) for Ad26.COV2.S, and 64·8% ( 54·9–72·4) for BNT162b2. For the two-dose vaccine series ( CoronaVac, ChAdOx1 nCoV-19, and BNT162b2), effectiveness against symptomatic infection was significantly greater after the second dose than after the first dose. Effectiveness against hospitalisation or death 14 or more days from vaccine series completion was 81·3% ( 75·3–85·8) for CoronaVac, 89·9% ( 83·5–93·8) for ChAdOx1 nCoV-19, 57·7% ( −2·6 to 82·5) for Ad26.COV2.S, and 89·7% ( 54·3–97·7) for BNT162b2.InterpretationAll four vaccines conferred additional protection against symptomatic infections and severe outcomes among individuals with previous SARS-CoV-2 infection. The provision of a full vaccine series to individuals after recovery from COVID-19 might reduce morbidity and mortality.FundingBrazilian National Research Council, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Oswaldo Cruz Foundation, JBS, Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Generalitat de Catalunya.
COVID-19 vaccines have proven highly effective among individuals without a previous SARS-CoV-2 infection, but their effectiveness in preventing symptomatic infection and severe outcomes among individuals with previous infection is less clear. We aimed to estimate the effectiveness of four COVID-19 vaccines against symptomatic infection, hospitalisation, and death for individuals with laboratory-confirmed previous SARS-CoV-2 infection.
Using national COVID-19 notification, hospitalisation, and vaccination datasets from Brazil, we did a test-negative, case-control study to assess the effectiveness of four vaccines ( CoronaVac [ Sinovac ], ChAdOx1 nCoV-19 [ AstraZeneca ], Ad26.COV2.S [ Janssen ], and BNT162b2 [ Pfizer-BioNtech ]) for individuals with laboratory-confirmed previous SARS-CoV-2 infection. We matched cases with RT-PCR positive, symptomatic COVID-19 with up to ten controls with negative RT-PCR tests who presented with symptomatic illnesses, restricting both groups to tests done at least 90 days after an initial infection. We used multivariable conditional logistic regression to compare the odds of test positivity and the odds of hospitalisation or death due to COVID-19, according to vaccination status and time since first or second dose of vaccines.
Between Feb 24, 2020, and Nov 11, 2021, we identified 213 457 individuals who had a subsequent, symptomatic illness with RT-PCR testing done at least 90 days after their initial SARS-CoV-2 infection and after the vaccination programme started. Among these, 30 910 ( 14·5%) had a positive RT-PCR test consistent with reinfection, and we matched 22 566 of these cases with 145 055 negative RT-PCR tests from 68 426 individuals as controls. Among individuals with previous SARS-CoV-2 infection, vaccine effectiveness against symptomatic infection 14 or more days from vaccine series completion was 39·4% ( 95% CI 36·1–42·6) for CoronaVac, 56·0% ( 51·4–60·2) for ChAdOx1 nCoV-19, 44·0% ( 31·5–54·2) for Ad26.COV2.S, and 64·8% ( 54·9–72·4) for BNT162b2. For the two-dose vaccine series ( CoronaVac, ChAdOx1 nCoV-19, and BNT162b2), effectiveness against symptomatic infection was significantly greater after the second dose than after the first dose. Effectiveness against hospitalisation or death 14 or more days from vaccine series completion was 81·3% ( 75·3–85·8) for CoronaVac, 89·9% ( 83·5–93·8) for ChAdOx1 nCoV-19, 57·7% ( −2·6 to 82·5) for Ad26.COV2.S, and 89·7% ( 54·3–97·7) for BNT162b2.
All four vaccines conferred additional protection against symptomatic infections and severe outcomes among individuals with previous SARS-CoV-2 infection. The provision of a full vaccine series to individuals after recovery from COVID-19 might reduce morbidity and mortality.
Brazilian National Research Council, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Oswaldo Cruz Foundation, JBS, Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Generalitat de Catalunya.
As of March 11, 2022, over 450 million confirmed cases of COVID-19 have been reported since the start of the pandemic,1WHOWHO coronavirus ( COVID-19) dashboard.https: //covid19.who.int/Date: 2021Date accessed: March 11, 2022Google Scholar and the true cumulative incidence has probably been several times greater.2Chen X Chen Z Azman AS et al.Serological evidence of human infection with SARS-CoV-2: a systematic review and meta-analysis.Lancet Glob Health. 2021; 9: e598-e609Google Scholar Within a year of the identification of SARS-CoV-2, multiple vaccines were developed, found to be highly efficacious among seronegative individuals in clinical trials, and introduced into national vaccination programmes.3Thomas SJ Moreira Jr, ED Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine through 6 months.N Engl J Med. 2021; 385: 1761-1773Google Scholar, 4Voysey M Clemens SAC Madhi SA et al.Safety and efficacy of the ChAdOx1 nCoV-19 vaccine ( AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.Lancet. 2021; 397: 99-111Google Scholar Coverage of COVID-19 vaccination has varied across populations due to inequalities in access and public hesitancy. Additionally, public debate has emerged about the need for vaccination among people who have had a previous SARS-CoV-2 infection5Block J Vaccinating people who have had COVID-19: why doesn't natural immunity count in the US?.BMJ. 2021; 374n2101Google Scholar and, if so, whether a single dose is sufficient.6Dolgin E Is one vaccine dose enough if you 've had COVID? What the science says.Nature. 2021; 595: 161-162Google Scholar, 7Frieman M Harris AD Herati RS et al.SARS-CoV-2 vaccines for all but a single dose for COVID-19 survivors.EBioMedicine. 2021; 68103401Google Scholar The emergence of more transmissible variants with enhanced immune escape, and the resulting waves of infection and reinfection, have renewed questions about the importance of vaccination in individuals who have had COVID-19.8Cele S Jackson L Khoury DS et al.Omicron extensively but incompletely escapes Pfizer BNT162b2 neutralization.Nature. 2021; ( published online Dec 23.) https: //doi.org/10.1038/s41586-021-04387-1Google Scholar, 9Pulliam JRC van Schalkwyk C Govender N et al.Increased risk of SARS-CoV-2 reinfection associated with emergence of the omicron variant in South Africa.medRxiv. 2021; ( published online Dec 2.) ( preprint).https: //doi.org/10.1101/2021.11.11.21266068Google Scholar
Research in contextEvidence before this studyWe searched PubMed, medRxiv, and SSRN for articles published from Jan 1, 2020, to Feb 14, 2022, with no language restrictions, using the search terms “ vaccine effectiveness ” AND “ previous * ” AND ( “ SARS-CoV-2 ” OR “ COVID-19 ”). We found several studies evaluating ChAdOx1 nCoV-19 ( AstraZeneca) and BNT162b2 ( tozinameran; Pfizer-BioNtech), and one additionally reporting on mRNA-1273 ( elasomeran; Moderna) and Ad26.COV2.S ( Janssen), which found that individuals who were previously infected and were vaccinated had lower risk of symptomatic SARS-CoV-2 infection than those who were unvaccinated. One study found that for individuals who were previously infected, the risk of hospitalisation was lower after a full series of BNT162b2 or mRNA-1273 than for those who were unvaccinated. One study reported on effectiveness of an inactivated virus vaccine ( BBV152; Bharat Biotech International) against reinfection, and no studies reported on effectiveness of CoronaVac among individuals who were previously infected. Scarce evidence is available comparing effectiveness of one dose versus two doses of vaccine among individuals with previous infection.Added value of this studyWe used national databases of COVID-19 case surveillance, laboratory testing, and vaccination from Brazil to investigate the effectiveness of CoronaVac, ChAdOx1 nCoV-19, Ad26.COV2.S, and BNT162b2 among individuals with a previous, laboratory-confirmed SARS-CoV-2 infection. We matched more than 22 000 RT-PCR-confirmed re-infections with more than 145 000 RT-PCR-negative controls, using a test-negative design. All four vaccines were effective against symptomatic SARS-CoV-2 infection, with effectiveness from 14 days after series completion ranging from 39·4% ( 95% CI 36·1–42·6) for CoronaVac to 64·8% ( 54·9–72·4) for BNT162b2. For vaccines with two-dose regimens, the second dose provided significantly increased effectiveness compared with one dose alone. Effectiveness against COVID-19-associated hospitalisation or death from 14 days after series completion was over 80% for CoronaVac, ChAdOx1 nCoV-19, and BNT162b2.Implications of all the available evidenceWe found evidence that these four vaccines, using three different platforms, all provide protection against symptomatic SARS-CoV-2 infection and severe outcomes to individuals who were previously infected, with a second dose conferring significant additional benefits. These results support the provision of a full vaccine series among individuals with previous SARS-CoV-2 infection.
We searched PubMed, medRxiv, and SSRN for articles published from Jan 1, 2020, to Feb 14, 2022, with no language restrictions, using the search terms “ vaccine effectiveness ” AND “ previous * ” AND ( “ SARS-CoV-2 ” OR “ COVID-19 ”). We found several studies evaluating ChAdOx1 nCoV-19 ( AstraZeneca) and BNT162b2 ( tozinameran; Pfizer-BioNtech), and one additionally reporting on mRNA-1273 ( elasomeran; Moderna) and Ad26.COV2.S ( Janssen), which found that individuals who were previously infected and were vaccinated had lower risk of symptomatic SARS-CoV-2 infection than those who were unvaccinated. One study found that for individuals who were previously infected, the risk of hospitalisation was lower after a full series of BNT162b2 or mRNA-1273 than for those who were unvaccinated. One study reported on effectiveness of an inactivated virus vaccine ( BBV152; Bharat Biotech International) against reinfection, and no studies reported on effectiveness of CoronaVac among individuals who were previously infected. Scarce evidence is available comparing effectiveness of one dose versus two doses of vaccine among individuals with previous infection.
We used national databases of COVID-19 case surveillance, laboratory testing, and vaccination from Brazil to investigate the effectiveness of CoronaVac, ChAdOx1 nCoV-19, Ad26.COV2.S, and BNT162b2 among individuals with a previous, laboratory-confirmed SARS-CoV-2 infection. We matched more than 22 000 RT-PCR-confirmed re-infections with more than 145 000 RT-PCR-negative controls, using a test-negative design. All four vaccines were effective against symptomatic SARS-CoV-2 infection, with effectiveness from 14 days after series completion ranging from 39·4% ( 95% CI 36·1–42·6) for CoronaVac to 64·8% ( 54·9–72·4) for BNT162b2. For vaccines with two-dose regimens, the second dose provided significantly increased effectiveness compared with one dose alone. Effectiveness against COVID-19-associated hospitalisation or death from 14 days after series completion was over 80% for CoronaVac, ChAdOx1 nCoV-19, and BNT162b2.
We found evidence that these four vaccines, using three different platforms, all provide protection against symptomatic SARS-CoV-2 infection and severe outcomes to individuals who were previously infected, with a second dose conferring significant additional benefits. These results support the provision of a full vaccine series among individuals with previous SARS-CoV-2 infection.
SARS-CoV-2 infection induces robust T-cell and B-cell responses,10Dan JM Mateus J Kato Y et al.Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection.Science. 2021; 371eabf4063Google Scholar and the risk of symptomatic infection and severe outcomes is lower among people with previous SARS-CoV-2 infection than among naive individuals.11Abu-Raddad LJ Chemaitelly H Bertollini R Severity of SARS-CoV-2 reinfections as compared with primary infections.N Engl J Med. 2021; 385: 2487-2489Google Scholar Emerging evidence suggests that vaccination with ChAdOx1 nCoV-19 ( AstraZeneca), Ad26.COV2.S ( Janssen), BNT162b2 ( tozinameran; Pfizer-BioNtech), or mRNA-1273 ( elasomeran; Moderna) confers additional protection against symptomatic reinfection among individuals with previous SARS-CoV-2 infection.12Cavanaugh AM Spicer KB Thoroughman D Glick C Winter K Reduced risk of reinfection with SARS-CoV-2 after COVID-19 vaccination—Kentucky, May–June 2021.MMWR Morb Mortal Wkly Rep. 2021; 70: 1081-1083Google Scholar, 13Gazit S Shlezinger R Perez G et al.Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections.medRxiv. 2021; ( published online Aug 25.) ( preprint).https: //doi.org/10.1101/2021.08.24.21262415Google Scholar, 14Abu-Raddad LJ Chemaitelly H Ayoub HH et al.Association of prior SARS-CoV-2 infection with risk of breakthrough infection following mRNA vaccination in Qatar.JAMA. 2021; 326: 1930-1939Google Scholar, 15Hall V Foulkes S Insalata F et al.Effectiveness and durability of protection against future SARS-CoV-2 infection conferred by COVID-19 vaccination and previous infection; findings from the UK SIREN prospective cohort study of healthcare workers March 2020 to September 2021.medRxiv. 2021; ( published online Dec 1.) ( preprint).http: //www.medrxiv.org/content/10.1101/2021.11.29.21267006v1Google Scholar, 16Pouwels KB Pritchard E Matthews PC et al.Effect of delta variant on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK.Nat Med. 2021; 27: 2127-2135Google Scholar, 17Monge S Olmedo C Alejos B Lapeña MF Sierra MJ Limia A Direct and indirect effectiveness of mRNA vaccination against severe acute respiratory syndrome coronavirus 2 in long-term care facilities, Spain.Emerg Infect Dis. 2021; 27: 2595-2603Google Scholar, 18Levin-Rector A Firestein L McGibbon E et al.Reduced odds of SARS-CoV-2 reinfection after vaccination among New York City adults, June–August 2021.medRxiv. 2021; ( published online Dec 11.) ( preprint).http: //www.medrxiv.org/content/10.1101/2021.12.09.21267203v1Google Scholar However, only one study has assessed protection against severe outcomes in previously infected individuals, with just 75 hospital admissions and two deaths.18Levin-Rector A Firestein L McGibbon E et al.Reduced odds of SARS-CoV-2 reinfection after vaccination among New York City adults, June–August 2021.medRxiv. 2021; ( published online Dec 11.) ( preprint).http: //www.medrxiv.org/content/10.1101/2021.12.09.21267203v1Google Scholar Moreover, data for inactivated vaccines, which account for almost half of all doses given globally, are still needed.19Mallapaty S China's COVID vaccines have been crucial—now immunity is waning.Nature. 2021; 598: 398-399Google Scholar
Brazil has recorded more than 22 million SARS-CoV-2 infections and 600 000 deaths as of Nov 15, 2021. On Jan 18, 2021, a national COVID-19 immunisation programme was initiated, which has used four vaccines of three different classes: inactivated virus ( CoronaVac; Sinovac), viral vector ( ChAdOx1 nCoV-19 and Ad26.COV2.S), and mRNA ( BNT162b2). We used national disease surveillance and vaccination databases to estimate the effectiveness of these four vaccines among individuals with laboratory-confirmed previous SARS-CoV-2 infection against symptomatic infection, hospitalisation, and death.
We did a test-negative, case-control study to evaluate the effectiveness of four vaccines ( CoronaVac, ChAdOx1 nCoV-19, Ad26.COV2.S, and BNT162b2) in individuals with previous SARS-CoV-2 infection in Brazil. The study population included individuals with a previous positive RT-PCR or rapid antigen test for SARS-CoV-2 who presented again to health facilities with symptomatic illness and were tested for SARS-CoV-2 at least 90 days after their first positive test.20WHOEnhancing response to omicron SARS-CoV-2 variant: technical brief and priority actions for member states.https: //www.who.int/docs/default-source/coronaviruse/2022-01-07-global-technical-brief-and-priority-action-on-omicron-corr2.pdf? sfvrsn=918b09d 23 & download=trueDate: 2022Date accessed: January 18, 2022Google Scholar We matched positive tests ( cases) to negative tests ( controls).
We used data from several national data sources: a deterministically linked dataset comprised of the Programa Nacional de Imunizações, which contains records of all vaccines administered in Brazil; the e-SUS Notifica, which contains records of suspected and confirmed COVID-19 cases in outpatient clinics; and the Sistema de Informação da Vigilância Epidemiológica da Gripe, which contains records of severe acute respiratory illnesses, including COVID-19 hospitalisations and deaths.21Ranzani OT Hitchings MDT Dorion M et al.Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of COVID-19 in Brazil: test negative case-control study.BMJ. 2021; 374n2015Google Scholar, 22Ranzani OT Bastos LSL Gelli JGM et al.Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data.Lancet Respir Med. 2021; 9: 407-418Google Scholar, 23Oliveira EA Colosimo EA Simões E Silva AC et al.Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.Lancet Child Adolesc Health. 2021; 5: 559-568Google Scholar, 24Cerqueira-Silva T Oliveira VA Boaventura VS et al.Influence of age on the effectiveness and duration of protection of Vaxzevria and CoronaVac vaccines: a population-based study.Lancet Reg Health Am. 2022; 6100154Google Scholar, 25Katikireddi SV Cerqueira-Silva T Vasileiou E et al.Two-dose ChAdOx1 nCoV-19 vaccine protection against COVID-19 hospital admissions and deaths over time: a retrospective, population-based cohort study in Scotland and Brazil.Lancet. 2022; 399: 25-35Google Scholar All data were pseudo-anonymised with a common unique identifier provided by the Brazilian Ministry of Health. The research protocol was approved by the Brazilian National Commission in Research Ethics ( 4.921.308).
Brazil's national COVID-19 immunisation programme commenced on Jan 18, 2021. Rollout plans were determined at the state and local level; health-care workers and older individuals were the first groups to be eligible, with age criteria for eligibility decreasing over time. Four vaccines have been offered in immunisation programmes in Brazil: CoronaVac, provided as a two-dose series with a 4-week interval between doses; ChAdOx1 nCoV-19, provided as a two-dose series with a 12-week interval between doses that was subsequently reduced to 8 weeks in some states; Ad26.COV2.S, provided as a single dose series; and BNT162b2, provided as a two-dose series with an initial 12-week interval that was subsequently reduced to 3 weeks in some states. Brazil's national guidelines recommend that individuals who were previously infected be vaccinated 4 weeks or more after infection, and this recommendation did not change during the study period.
Inclusion criteria for this study included age 18 years or older, previous SARS-CoV-2 infection confirmed by RT-PCR or rapid antigen test, and a second exam ( RT-PCR test) fulfilling the following criteria: being associated with an event of acute respiratory symptomatic illness and occurring within 10 days of symptom onset, being done at least 90 days after the individual's first positive test, and occurring after the vaccination programme began in Brazil ( Jan 18, 2021). We included individuals whose first infection occurred between Feb 24, 2020, and Aug 13, 2021, and with a subsequent RT-PCR test being done between Jan 18, 2021, and Nov 11, 2021.
We excluded individuals for whom data were incomplete on age, sex, location of residence, vaccination status, or testing status or dates; those who received different vaccines for their first and second dose; those whose time interval between the first and second doses was less than 14 days; and those vaccinated before the first infection or less than 14 days after the first infection. For tests, we excluded negative tests that were followed by a positive test within 7 days ( to avoid misclassification of cases as controls), tests done after the second positive test, tests for which the individual's symptom onset date occurred after notification of the suspected case in the surveillance system ( to exclude individuals without symptoms at the time of testing), tests done in individuals without symptoms, and tests done after a third vaccine dose, as this analysis was not powered to examine effectiveness of third doses. In some cases, more than one negative test from one individual was available for matching, and we included these as candidates for matching if they met the described eligibility criteria.
We matched cases, defined as positive SARS-CoV-2 RT-PCR tests from previously infected, symptomatic individuals, with controls, defined as negative SARS-CoV-2 RT-PCR tests from previously infected, symptomatic individuals. We did not attempt to ascertain causality between SARS-CoV-2 infection and hospitalisation or death as this information was not available. Instead, we defined hospitalisation or death related to COVID-19 using a commonly used, temporally defined surveillance case definition for COVID-19-related outcomes: a positive SARS-CoV-2 RT-PCR test accompanied by hospital admission or death occurring within 28 days of the sample collection date. For the analysis of hospitalisation or death, we selected matched sets from the overall matched dataset in which cases were positive tests from patients admitted to hospital or who died, and we fitted the model described to each subset. For severe outcomes, controls thus represented negative tests from patients in ambulatory or hospital settings who had RT-PCR testing, to reflect the population at risk for that outcome. We did not require controls for the severe outcomes analysis to be negative tests from patients admitted to hospital or who died, as the goal was to estimate overall effectiveness against severe outcomes. We matched one case to a maximum of ten controls, with replacement, by date of RT-PCR testing ( ±10 days), age ( ±5 years), sex, and municipality of residence. Individuals who were selected as cases could also serve as controls if they had negative tests that were collected more than 7 days before their positive test.
We calculated standardised differences for demographic characteristics of matched cases and controls, considering a difference higher than 0·1 for variables not included in the exact match to be significant; 26Flury BK Riedwyl H Standard distance in univariate and multivariate analysis.Am Stat. 1986; 40: 249-251Google Scholar, 27Austin PC Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.Commun Stat Simul Comput. 2009; 38: 1228-1234Google Scholar for exact matched variables, no differences exist within each stratum of the analysis. The primary exposure of interest was vaccination status, which was categorised by vaccine and according to the vaccination status of the individual at the time of RT-PCR test collection as unvaccinated, 0–13 days after the first dose, 14 days or more after the first dose, 0–13 days after the second dose, or 14 days or more after the second dose. Post-second dose status is not applicable to Ad26.COV2.S. We considered vaccine effectiveness against symptomatic SARS-CoV-2 infection and against COVID-19-related hospitalisation or death among individuals with previous confirmed SARS-CoV-2 infection 14 days or more after vaccine series completion ( two doses for CoronaVac, ChAdOx1 nCoV-19, and BNT162b2 and one dose for Ad26.COV2.S) to be the primary estimands of interest. We considered effectiveness in the 6 days after the first vaccine dose to be an indicator of bias, because we expected protection to be minimal during this time and substantial differences in risk could reflect residual confounding between the vaccinated and unvaccinated populations.28Hitchings MDT Lewnard JA Dean NE et al.Use of recently vaccinated individuals to detect bias in test-negative case-control studies of COVID-19 vaccine effectiveness.medRxiv. 2021; ( published online July 2.) ( preprint).https: //doi.org/10.1101/2021.06.23.21259415Google Scholar
We estimated vaccine effectiveness ( 1–odds ratio) using conditional logistic regression, accounting for the matched design, with vaccination status ( including number of doses and time period since dose) as the predictor and adjusting for the number of reported chronic comorbidities ( diabetes, cardiovascular disease, obesity, chronic kidney disease, and immunosupression, categorised as none, one, and at least two), pregnancy, postpartum period, self-reported race, days elapsed between the first positive test and the second test ( as a restricted cubic spline), and whether the individual was admitted to hospital during their first SARS-CoV-2 infection. For severe outcomes, age ( as a continuous variable) was also included due to anticipated residual confounding and observed improved model fit and Bayesian Information Criterion.
We did subgroup analyses in which we assessed vaccine effectiveness by age ( 18–49 years vs ≥50 years), time since vaccine series completion ( 14–90 days vs > 90 days; to assess for possible waning), and time from initial positive test to vaccination ( 91–180 days vs 181–613 days). We used generalised linear hypothesis tests for comparisons across different vaccination status, and the confidence intervals and p values were not adjusted for multiple comparisons. All data processing and analyses were done in R ( version 4.1.1), using the packages tidyverse, multcomp, MatchIt, and survival.
Julio Croda is affiliated with Oswaldo Cruz and received support from the Oswaldo Cruz Foundation for this work. The Oswaldo Cruz Foundation and the other funders of the study did not have any further role in study design, data collection, data analysis, data interpretation, or writing of the report.
Brazil has had two COVID-19 epidemic waves up to the end of 2021, with the first occurring between July and September 2020, and the second between February and June 2021, during which the gamma ( P.1) variant was dominant ( figure 1). Brazil's national vaccination programme commenced on Jan 18, 2021; 50% of the adult population ( 83 million individuals) had received a first vaccine dose by July 7, 2021. Between Feb 24, 2020, and Nov 11, 2021, more than 23 million individuals had valid SARS-CoV-2 tests and 11 million were confirmed cases ( figure 2). Among these, we identified 213 457 individuals who had a subsequent, symptomatic illness with RT-PCR testing done at least 90 days after their initial SARS-CoV-2 infection and after the vaccination programme commenced. Among these, 30 910 ( 14·5%) had a positive RT-PCR test consistent with reinfection. We matched 22 566 of these cases with 145 055 negative RT-PCR tests from 68 426 individuals as controls. Among cases, 1545 ( 6·8%) were admitted to hospital and 290 ( 1·3%) died within 28 days of a positive SARS-CoV-2 RT-PCR; 1564 ( 6·9%) were admitted to hospital or died ( table).Figure 1Temporal trends in COVID-19 cases, hospitalisation or deaths, variants, and vaccination coverage from national databases in BrazilShow full captionWeekly numbers of symptomatic COVID-19 cases ( A); COVID-19-associated hospitalisations or deaths reported in national databases ( B); monthly proportions of variants among sequenced SARS-CoV-2 samples, with the number of sequenced viruses shown above each bar ( C); and cumulative proportion of the population older than 11 years who received a first ( D) or second ( E) dose of each vaccine. VOC=variant of concern. VOI=variant of interest.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) Figure 2Flowchart of the study population from surveillance databases and selection of matched cases and controlsShow full captionCases and controls were matched on age ( ±5 years), sex, municipality, and date of test ( ±10 days).View Large Image Figure ViewerDownload Hi-res image Download ( PPT) TableCharacteristics, vaccination status, and outcomes of individuals eligible for and matched into case-control setsEligible populationMatched setsStandardised differenceCasesControlsCasesControlsIndividuals30 910182 54722 56668 426.. Tests30 910196 54922 566145 055.. Age, years38 ( 29–47) 37 ( 28–47) 37 ( 29–46) 36 ( 29–44) 0·066Sex........ 0·047Female18 106 ( 58·6%) 119 134 ( 60·6%) 13 631 ( 60·4%) 90 931 ( 62·7%).. Male12 804 ( 41·4%) 77 415 ( 39·4%) 8935 ( 39·6%) 54 124 ( 37·3%).. Race........ 0·039White13 841 ( 44·8%) 109 923 ( 55·9%) 10 302 ( 45·7%) 67 403 ( 46·5%).. Mixed11 363 ( 36·8%) 53 401 ( 27·2%) 7998 ( 35·4%) 50 788 ( 35·0%).. Black1420 ( 4·6%) 9034 ( 4·6%) 1052 ( 4·7%) 7572 ( 5·2%).. Indigenous or Asian2081 ( 6·7%) 9305 ( 4·7%) 1437 ( 6·4%) 8751 ( 6·0%).. Missing2205 ( 7·1%) 14 886 ( 7·6%) 1777 ( 7·9%) 10 541 ( 7·3%).. Region of residence........ 0·085Central west3260 ( 10·5%) 46 968 ( 23·9%) 2302 ( 10·2%) 12 997 ( 9·0%).. North2406 ( 7·8%) 9724 ( 4·9%) 1870 ( 8·3%) 12 372 ( 8·5%).. Northeast8268 ( 26·7%) 30 027 ( 15·3%) 5297 ( 23·5%) 30 489 ( 21·0%).. South2823 ( 9·1%) 16 251 ( 8·3%) 1991 ( 8·8%) 14 745 ( 10·2%).. Southeast14 153 ( 45·8%) 93 579 ( 47·6%) 11 106 ( 49·2%) 74 452 ( 51·3%).. Residence in state capital9250 ( 29·9%) 51 128 ( 26·0%) 8982 ( 39·8%) 77 198 ( 53·2%) 0·271Medical comorbidities.......... None25 988 ( 84·1%) 166 655 ( 84·8%) 19 271 ( 85·4%) 124 964 ( 86·1%) 0·027One3552 ( 11·5%) 22 178 ( 11·3%) 2459 ( 10·9%) 15 360 ( 10·6%).. Two or more1370 ( 4·4%) 7716 ( 3·9%) 836 ( 3·7%) 4731 ( 3·3%).. Days from first positive test to second test210 ( 144–285) 217 ( 154–293) 216 ( 146–291) 223 ( 154–295) 0·060Hospitalised during first infection1220 ( 3·9%) 9481 ( 4·8%) 781 ( 3·5%) 6507 ( 4·5%) 0·052Hospitalisation ( up to 28 days) 2508 ( 8·1%) 3770 ( 1·9%) 1545 ( 6·8%) 2196 ( 1·5%).. Death ( up to 28 days) 559 ( 1·8%) 663 ( 0·3%) 290 ( 1·3%) 386 ( 0·3%).. Hospitalisation or death2554 ( 8·3%) 3829 ( 1·9%) 1564 ( 6·9%) 2238 ( 1·5%).. Data are n, n (%), or median ( IQR). Percentages were calculated using number of tests as the denominator. Matching was based on tests rather than individuals, with up to ten controls matched, with replacement, per case. Open table in a new tab
Weekly numbers of symptomatic COVID-19 cases ( A); COVID-19-associated hospitalisations or deaths reported in national databases ( B); monthly proportions of variants among sequenced SARS-CoV-2 samples, with the number of sequenced viruses shown above each bar ( C); and cumulative proportion of the population older than 11 years who received a first ( D) or second ( E) dose of each vaccine. VOC=variant of concern. VOI=variant of interest.
Cases and controls were matched on age ( ±5 years), sex, municipality, and date of test ( ±10 days).
Data are n, n (%), or median ( IQR). Percentages were calculated using number of tests as the denominator. Matching was based on tests rather than individuals, with up to ten controls matched, with replacement, per case.
Demographics and clinical characteristics of eligible and matched sets are presented in the table. The median age of the matched population was 36 years ( IQR 29–44), approximately 60% of cases and controls were women, and the median time between first infection and the subsequent RT-PCR test was similar between cases ( 216 days, IQR 146–291) and controls ( 223 days, 154–295). The southeast region of Brazil, which includes São Paulo and Rio de Janeiro and is the most populous region, accounted for 49·2% of matched cases and 51·3% of controls. This was followed by the northeast region, which is the second most populous region, and then the central-west, south, and north regions ( table). 39·8% of cases and 53·2% of controls resided in a state capital; due to exact matching on city, we observed no differences within each stratum of analysis.
The majority of cases ( 14 566 [ 64·5% ] of 22 566) and controls ( 83 290 [ 57·4% ] of 145 055) were unvaccinated at the time of the test. Among vaccinated individuals ( 39 717), 17 008 ( 42·8%) received CoronaVac, 15 897 ( 40·0%) received ChAdOx1 nCoV-19, 5 935 ( 14·9%) received BNT162b2, and 877 ( 2·2%) received Ad26.COV2.S. Demographic characteristics were similar among vaccine recipients included in the analysis, but recipients of ChAdOx1 nCoV-19 tended to be older ( p < 0·0001) and have more comorbidities ( p < 0·0001; appendix pp 2–3). The median time between vaccination and testing was 34 days ( IQR 17–61) for individuals who received only one dose and 59 days ( 27–105) for individuals who received two doses, which differed by each vaccine ( appendix p 12).
Effectiveness against symptomatic SARS-CoV-2 reinfection 14 days or more from vaccine series completion was 39·4% ( 95% CI 36·1–42·6) for CoronaVac, 56·0% ( 51·4–60·2) for ChAdOx1 nCoV-19, 44·0% ( 31·5–54·2) for Ad26.COV2.S, and 64·8% ( 54·9–72·4) for BNT162b2 ( figure 3). The two-dose vaccines ( CoronaVac, ChAdOx1 nCoV-19, and BNT162b2) all showed a significant increase in protection from 14 days or more after the first dose to 14 days or more after the second dose. For CoronaVac, effectiveness was twice as high in the period of 14 days or more after the second dose compared with that in 14 days or more after the first ( p < 0·0001). Only CoronaVac showed protection ( 21·0%, 2·3–36·1) against symptomatic infection within 6 days of the first dose, which we used as a test of bias ( appendix p 4).Figure 3Effectiveness of BNT162b2, ChAdOx1 nCoV-19, CoronaVac, and Ad26.COV2.S vaccines against symptomatic COVID-19 among individuals with previous SARS-CoV-2 infectionView Large Image Figure ViewerDownload Hi-res image Download ( PPT)
From 14 days after completion of the vaccine series, effectiveness against COVID-19-related hospitalisation or death was 81·3% ( 75·3–85·8) for CoronaVac, 89·9% ( 83·5–93·8) for ChAdOx1 nCoV-19, 57·7% ( −2·6 to 82·5) for Ad26.COV2.S, and 89·7% ( 54·3–97·7) for BNT162b2 ( figure 4). Effectiveness 14 days or more after a single dose was lowest for CoronaVac ( 35·3%, 7·9–54·5). Effectiveness against hospitalisation or death was significantly greater 14 days or more after two doses than 14 days or more after one dose for CoronaVac ( p < 0·0001) and ChAdOx1 nCoV-19 ( p < 0·0001), whereas for BNT162b2, the increase was not significant ( p=0·091). We found no evidence of protection for all four vaccines against COVID-19-related hospitalisation or death within 6 days of the first dose ( appendix p 4).Figure 4Effectiveness of BNT162b2, ChAdOx1 nCoV-19, CoronaVac, and Ad26.COV2.S vaccines against COVID-19-associated hospitalisation or death among individuals with previous SARS-CoV-2 infectionShow full caption * 95% CI could not be estimated owing to zero events in this group.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
* 95% CI could not be estimated owing to zero events in this group.
For the primary estimands of vaccine effectiveness against symptomatic SARS-CoV-2 infection and against COVID-19-related hospitalisation or death 14 days or more after vaccine series completion, we found no differences between age groups ( ≥50 years vs 18–49 years; appendix p 5). For three of the vaccines, we saw a non-significant increase in effectiveness against symptomatic infection for vaccination given more than 180 days after previous infection compared with 91–180 days, whereas we observed a significant increase for BNT162b2 ( 35·3% vs 70·7%, p=0·011; appendix p 5). We found no differences in effectiveness against symptomatic infection when comparing the periods of 14–90 days and more than 90 days after vaccine series completion. For hospitalisation and death, effectiveness of ChAdOx1 nCoV-19 was greater at more than 90 days after completion compared with that at 14–90 days ( 95·1% vs 86·6%; p=0·007), whereas effectiveness was lower for CoronaVac at more than 90 days than at 14–90 days ( 74·4% vs 86·6%, p=0·012; appendix p 5).
In this nationwide, population-based study among individuals with confirmed previous SARS-CoV-2 infection, we observed a high degree of additional protection of four vaccines against symptomatic COVID-19 and severe outcomes. For the three vaccines with two doses ( CoronaVac, ChAdOx1 nCoV-19, and BNT162b2), additional protection against symptomatic infection was observed after the second dose, reaching 39% to 65%, and protection against hospitalisation or death exceeded 80% 14 days or more after the second dose. These results support vaccination, including the full vaccine series, among individuals with previous SARS-CoV-2 infection.
Public debate has occurred about whether individuals who were previously infected need to be vaccinated, due to substantial immunity conferred by SARS-CoV-2 infection.5Block J Vaccinating people who have had COVID-19: why doesn't natural immunity count in the US?.BMJ. 2021; 374n2101Google Scholar Additionally, in view of data showing robust immune responses after a first vaccine dose in individuals who were previously infected, some have argued that two doses are not necessary.6Dolgin E Is one vaccine dose enough if you 've had COVID? What the science says.Nature. 2021; 595: 161-162Google Scholar, 7Frieman M Harris AD Herati RS et al.SARS-CoV-2 vaccines for all but a single dose for COVID-19 survivors.EBioMedicine. 2021; 68103401Google Scholar Indeed, several countries recommend that a single vaccine dose is sufficient for individuals who were previously infected.29Federal Office of Public HealthSwitzerland. Coronavirus: vaccination.https: //www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/impfen.html # -995735508Date: 2021Date accessed: December 16, 2021Google Scholar, 30German Federal Ministry of HealthProof of vaccination as defined in the COVID-19 protective measures exemption directive and the directive on coronavirus entry regulations.https: //www.pei.de/EN/newsroom/dossier/coronavirus/coronavirus-content.html? cms pos=3Date: 2021Date accessed: December 16, 2021Google Scholar, 31Haute Autorité de SantéStratégie de vaccination contre le SARS-CoV-2—vaccination des personnes ayant un antécédent de COVID-19.https: //www.has-sante.fr/jcms/p 3237271/en/strategie-de-vaccination-contre-le-sars-cov-2-vaccination-des-personnes-ayant-un-antecedent-de-covid-19Date: 2021Date accessed: December 16, 2021Google Scholar We found that a second dose of CoronaVac, ChAdOx1 nCoV-19, and BNT162b2 provided significant additional protection against symptomatic infections and severe disease. A recent study has shown that IgG antibodies to the receptor binding domain in individuals who recovered from COVID-19 declined to about 35% of their individual level by 9 months.32Li C Yu D Wu X et al.Twelve-month specific IgG response to SARS-CoV-2 receptor-binding domain among COVID-19 convalescent plasma donors in Wuhan.Nat Commun. 2021; 124144Google Scholar Additionally, repeated antigen exposures were observed to increase antibody diversity, which might improve protection against emergent variants.32Li C Yu D Wu X et al.Twelve-month specific IgG response to SARS-CoV-2 receptor-binding domain among COVID-19 convalescent plasma donors in Wuhan.Nat Commun. 2021; 124144Google Scholar Taken together, these findings might help explain the additional benefits of a second vaccine dose among individuals who were previously infected, despite robust immune responses to the first dose.33Muecksch F Weisblum Y Barnes CO et al.Affinity maturation of SARS-CoV-2 neutralizing antibodies confers potency, breadth, and resilience to viral escape mutations.Immunity. 2021; 54 ( 68.e7): 1853Google Scholar
The results of this analysis are consistent with studies reporting that individuals with previous SARS-CoV-2 infection who received ChAdOx1 nCoV-19 and BNT162b2 had a lower risk of symptomatic COVID-19 than those who were previously infected and unvaccinated.12Cavanaugh AM Spicer KB Thoroughman D Glick C Winter K Reduced risk of reinfection with SARS-CoV-2 after COVID-19 vaccination—Kentucky, May–June 2021.MMWR Morb Mortal Wkly Rep. 2021; 70: 1081-1083Google Scholar, 13Gazit S Shlezinger R Perez G et al.Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections.medRxiv. 2021; ( published online Aug 25.) ( preprint).https: //doi.org/10.1101/2021.08.24.21262415Google Scholar, 15Hall V Foulkes S Insalata F et al.Effectiveness and durability of protection against future SARS-CoV-2 infection conferred by COVID-19 vaccination and previous infection; findings from the UK SIREN prospective cohort study of healthcare workers March 2020 to September 2021.medRxiv. 2021; ( published online Dec 1.) ( preprint).http: //www.medrxiv.org/content/10.1101/2021.11.29.21267006v1Google Scholar, 16Pouwels KB Pritchard E Matthews PC et al.Effect of delta variant on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK.Nat Med. 2021; 27: 2127-2135Google Scholar Direct comparison with vaccine effectiveness estimates from these studies is challenged by differences in design, with most studies reporting risk in comparison with individuals who were unvaccinated and without a previous SARS-CoV-2 infection. However, inferred protection from those studies ranged from 40% to 94%, consistent with the magnitude of protection against symptomatic infection found for ChAdOx1 nCoV-19 ( 56·0%) and BNT162b2 ( 64·8%) in this study. Our analysis also adds new estimates on effectiveness of the CoronaVac and Ad26.COV2.S vaccines among individuals who were previously infected, finding that these vaccines provide more modest levels of protection against symptomatic infection, consistent with their lower effectiveness in naive populations.21Ranzani OT Hitchings MDT Dorion M et al.Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of COVID-19 in Brazil: test negative case-control study.BMJ. 2021; 374n2015Google Scholar, 34Zheng C Shao W Chen X Zhang B Wang G Zhang W Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis.Int J Infect Dis. 2022; 114: 252-260Google Scholar Concerns have been raised about less robust and durable neutralising antibody responses in individuals naive to SARS-CoV-2 who have received CoronaVac compared with other vaccines.35Lim WW Mak L Leung GM Cowling BJ Peiris M Comparative immunogenicity of mRNA and inactivated vaccines against COVID-19.Lancet Microbe. 2021; 2: e423Google Scholar We found that two doses of CoronaVac provided high levels of protection against severe outcomes ( 81·3%, 95% CI 75·3–85·8). As CoronaVac is among the most widely used vaccines in the world, these findings have broad implications for many national programmes.19Mallapaty S China's COVID vaccines have been crucial—now immunity is waning.Nature. 2021; 598: 398-399Google Scholar
To our knowledge, only one previous study reported vaccine effectiveness against COVID-19-related hospitalisation or death among individuals who were previously infected; with just 75 outcomes and three vaccines evaluated, the power of that study was limited for assessing vaccine and dose-specific effectiveness, but estimates ranged from 58% ( BNT162b2) to 68% ( mRNA-1273), with no significant protection from Ad26.COV2.S.18Levin-Rector A Firestein L McGibbon E et al.Reduced odds of SARS-CoV-2 reinfection after vaccination among New York City adults, June–August 2021.medRxiv. 2021; ( published online Dec 11.) ( preprint).http: //www.medrxiv.org/content/10.1101/2021.12.09.21267203v1Google Scholar We found that protection against these severe outcomes, from 14 days after the second dose, was greater than 80% for the three two-dose vaccines ( CoronaVac, ChAdOx1 nCoV-19, and BNT162b2). These results are consistent with recent data showing that individuals who were previously infected have even greater increases in T-cell and B-cell responses after vaccination than those without previous infection.36Angyal A Longet S Moore SC et al.T-cell and antibody responses to first BNT162b2 vaccine dose in previously infected and SARS-CoV-2-naive UK health-care workers: a multicentre prospective cohort study.Lancet Microbe. 2021; 3: e21-e31Google Scholar This high degree of hybrid immunity, from infections and vaccination, might explain why Brazil, despite having similar vaccination coverage as the USA and many European countries, did not have a similar increase in hospitalisations and deaths in the period in which the delta ( B.1.617.2) variant become dominant.
Effectiveness against severe outcomes was lower ( 57·7%) for the single-dose Ad26.COV2.S vaccine than for the vaccines given in two-dose series, although the confidence limits were wide. The Ad26.COV2.S vaccine was used in a more focal rollout from June to July, 2021, and far fewer individuals received this vaccine compared with the others, such that we had modest power to characterise the effectiveness of this vaccine against severe outcomes. Brazil's Ministry of Health now recommends that individuals who received this vaccine receive a second dose after 60 days.
We focused our analyses on individuals who were previously infected to address the question of whether and to what extent vaccines confer additional protection against symptomatic infection and severe outcomes. We did not compare against individuals without a previous infection because their risk of exposure might be different, which could lead to biased estimates in this population-based study. Additionally, the misclassification of individuals who were previously infected as not having been previously infected is a substantial risk, due to incomplete surveillance and asymptomatic infections; restricting vaccine effectiveness analysis to individuals with PCR-confirmed previous infection avoids this bias. Although much discussion has occurred concerning the relative protection conferred by infection-derived and vaccine-derived immunity, from a medical and public health standpoint, the crucial question is understanding whether individuals with previous infection would benefit from vaccination. This study suggests that individuals infected before vaccination benefit from strong protection against severe outcomes with all four vaccines studied.
A major difficulty with observational studies of vaccine effectiveness is the risk of confounding, whereby differences in the vaccinated and unvaccinated populations are associated with the risk of a COVID-19 diagnosis. The matched, test-negative design has been recommended by WHO to mitigate risk of confounding introduced by care-seeking and diagnostic access; nevertheless, residual confounding might occur. We used vaccine effectiveness in the 6 days after the first dose as a bias indicator, in that differences during this period before vaccine-conferred protection is expected could indicate confounding.28Hitchings MDT Lewnard JA Dean NE et al.Use of recently vaccinated individuals to detect bias in test-negative case-control studies of COVID-19 vaccine effectiveness.medRxiv. 2021; ( published online July 2.) ( preprint).https: //doi.org/10.1101/2021.06.23.21259415Google Scholar We only observed significant effectiveness in this time interval for one vaccine ( CoronaVac) and one outcome ( symptomatic infection); over the 7–13-day time window, no effectiveness for this vaccine was observed ( appendix p 4). Whether the effectiveness observed over days 0–6 reflects bias or chance among the eight bias indicator tests ( 4 vaccines with 2 outcomes each) is unclear, but the absence of effects in the 7–13-day window might point away from systematic differences in recipients of CoronaVac regarding SARS-CoV-2 risk. For BNT162b2, we found modest protection in the 7–13-day window ( appendix p 4). In clinical trials of BNT162b2, efficacy was apparent from approximately 11 days after the first dose.3Thomas SJ Moreira Jr, ED Kitchin N et al.Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine through 6 months.N Engl J Med. 2021; 385: 1761-1773Google Scholar Given the rapid and robust immune responses after first vaccination among individuals who were previously infected, we believe these findings are consistent with early vaccine-conferred immunity.
This study has several limitations. First, we were not powered to assess vaccine effectiveness by age groups. We compared effectiveness in individuals older and younger than 50 years and did not observe major differences. The mean age of our study population was 36 years, with 75% younger than 45 years; these findings might not generalise to older populations. Second, there were differences in the timing of introduction and eligibility for each of the vaccines. This should prompt some caution in the comparison of effectiveness between vaccines, as the calendar period and median duration from second dose differed somewhat between vaccines. For example, if effectiveness wanes over time, vaccines used earlier would have lower effectiveness than those introduced later. Additionally, changes in variant distribution during the study period could alter effectiveness by time since vaccination. We did not have individual-level data on variants, which precluded assessment of variant-specific vaccine effectiveness. Different types and collection methods for RT-PCR tests are used throughout the country, which might have varying accuracy, and specific information about these characteristics are not recorded in the national databases. We used a matched, test-negative design with multivariable regression to reduce non-vaccine-related differences between cases and controls; however, unmeasured differences could exist that lead to confounding.37Lewnard JA Patel MM Jewell NP et al.Theoretical framework for retrospective studies of the effectiveness of SARS-CoV-2 vaccines.Epidemiology. 2021; 32: 508-517Google Scholar In particular, there were differences in the allocation of specific vaccines that might have been associated with unmeasured risk of COVID-19 or severe outcomes, which should prompt caution in the comparison of vaccine effectiveness between vaccines. This study included individuals who presented to health facilities and underwent diagnostic testing who might differ from individuals who did not seek medical care and might not be generalisable to that population. Finally, our study was unable to address the important question of when vaccines should be given to individuals with previous SARS-CoV-2 infection. To avoid misclassification of reinfections, we only considered tests done at least 90 days after the initial infection.
The accelerated development of effective vaccines against COVID-19 has been a remarkable scientific achievement but, as of March 11, 2022, 37·4% of the world's population has yet to receive a first dose, and a substantial proportion of these individuals have already been infected with SARS-CoV-2.1WHOWHO coronavirus ( COVID-19) dashboard.https: //covid19.who.int/Date: 2021Date accessed: March 11, 2022Google Scholar The results of this study provide evidence for the benefits of vaccination among individuals who have already been infected with SARS-CoV-2, with all four studied vaccines conferring substantial reductions in hospitalisation and death due to COVID-19. Ensuring vaccine access to individuals with previous infection might be particularly important amid reports of the omicron ( B.1.1.529) variant, which suggest that immunity conferred by previous infection is reduced.9Pulliam JRC van Schalkwyk C Govender N et al.Increased risk of SARS-CoV-2 reinfection associated with emergence of the omicron variant in South Africa.medRxiv. 2021; ( published online Dec 2.) ( preprint).https: //doi.org/10.1101/2021.11.11.21266068Google Scholar, 10Dan JM Mateus J Kato Y et al.Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection.Science. 2021; 371eabf4063Google Scholar, 38Andrews N Stowe J Kirsebom F et al.COVID-19 vaccine effectiveness against the omicron ( B.1.1.529) variant.N Engl J Med. 2022; ( published online March 2.) https: //doi.org/10.1056/NEJMoa2119451Google Scholar The expanded, equitable rollout of vaccines for all individuals remains crucial for mitigating the continued threat posed by SARS-CoV-2.
JRA, JC, and MB-N conceived the idea for the study. All authors contributed to the study design. TC-S, JRA, and OTR developed the statistical analysis plan and wrote the code for statistical analyses. TC-S, VdAO, JBJ, and MB-N had access to the raw data, and TC-S and MB-N verified the underlying data. TC-S, MB-N, VdAO, and MLB organised the data linkage. All authors contributed to interpretation of the study findings. JRA and TC-S drafted the manuscript. All authors critically revised the manuscript and approved the final version for submission.
One of the study coordinators ( MB-N) signed a term of responsibility on using each database made available by the Brazilian Ministry of Health. Each member of the research team signed a term of confidentiality before accessing the data. Data were manipulated in a secure computing environment, ensuring protection against data leakage. The Brazilian National Commission in Research Ethics approved the research protocol ( CONEP approval number 4.921.308). Our agreement with the Ministry of Health for accessing the databases patently denies authorisation of access to a third party. Any request for assessing the databases must be addressed to the Brazilian Ministry of Health. We used anonymised secondary data following the Brazilian Personal Data Protection General Law, but they are vulnerable to re-identification by third parties as they contain dates of relevant health events regarding the same person. To protect the research participants ' privacy, the approved research protocol authorises only the dissemination of aggregated data, such as the ones presented here.
MB-N reports grants from the Fazer o Bem Faz Bem programme from JBS. AIK reports grants from Bristol Myers Squibb, Regeneron, and Serimmune; and grants and personal fees from Tata Medical Devices, outside the submitted work. VdAO, VSB, MLB, JC, and MB-N are employees of Fiocruz, a federal public institution, which manufactures Vaxzevria ( ChAdOx1 nCoV-19 vaccine) in Brazil through a full technology transfer agreement with AstraZeneca. Fiocruz allocates all its manufactured products to the Ministry of Health for public health use. All other authors declare no competing interests.
This study was partly supported by a donation from the Fazer o Bem Faz Bem programme from JBS. GLW, MLB, JC, and MB-N are research fellows from the Brazilian National Research Council. GLW acknowledges the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro ( E-26/210.180/2020). JC is supported by the Oswaldo Cruz Foundation ( Edital COVID-19—resposta rápida 48111668950485). OTR is funded by a Sara Borrell fellowship ( CD19/00110) from the Instituto de Salud Carlos III. OTR acknowledges support from the Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa 2019–2023 programme and from the Generalitat de Catalunya through the Centres de Recerca de Catalunya programme.
Download.pdf (.93 MB) Help with pdf files Supplementary appendix
Effectiveness of SARS-CoV-2 vaccines in the post-natural infection worldNatural viral infections provide immunity from subsequent infection through a repertoire of memory T cells and B cells, except when the virus mutates to an extent that it evades recognition by memory cells.1 Vaccines are designed to represent the virus either in the form of an inactivated or attenuated whole virus or an immunogenic subunit such as the spike protein in the case of SARS-CoV-2.2 After a natural infection, the immune system assesses the virus in multiple ways and provides both antibody-mediated and cellular protection. Full-Text PDF | tech |
The Aboriginal Tent Embassy at 50: the history of an ongoing protest for Indigenous sovereignty in Australia – podcast | Aboriginal and Torres Strait Islander readers and listeners are advised this article and podcast contain names of deceased people.
The Aboriginal Tent Embassy – a site of First Nations protest in Canberra, Australia – marks its 50th anniversary this year. In this episode of The Conversation Weekly podcast, we hear about its history and how the ongoing protest has influenced a new generation of Indigenous activism.
Plus, new research into how the COVID-19 pandemic is affecting the lives of young people born into poverty around the world – and their job prospects.
On the morning of January 26, 1972, four young Aboriginal men left Sydney for the Australian capital, Canberra. When they arrived, they sat down on the lawns outside parliament house, erected a beach umbrella and held up a sign that said “ Aboriginal embassy ”. They were protesting against a speech by the government, which dismissed hopes for Aboriginal land rights.
For most of the following 50 years, the Aboriginal Tent Embassy has kept up a presence on the lawn in front of what is now Old Parliament House in Canberra. It has become a symbol of an enduring fight for Indigenous sovereignty in Australia. It’ s also survived attacks and controversies, most recently from a group calling themselves the “ Original Sovereigns ” who tried to hijack the Tent Embassy.
In this episode of The Conversation Weekly podcast, Carissa Lee, First Nations and public policy editor at The Conversation in Australia, yarns with two Indigenous researchers about the enduring place the Tent Embassy plays in the fight for Indigenous land rights and justice.
Bronwyn Carlson is a professor of Indigenous studies and director of the Centre for Global Indigenous Futures at Macquarie University in Sydney. “ While the Tent Embassy is primarily a symbol of land rights, it means so much more, ” she says. “ It’ s actually a symbol against the power that’ s unlawfully in place across this continent that continues to oppress Indigenous people and deny us our rights as sovereign peoples to this place. ”
Lynda-June Coe, a PhD candidate at Macquarie University, has family ties to the Tent Embassy and first visited as a child in the late 1980s. “ I can remember my aunties and uncles standing up having very fiery, very robust conversations with other First Nations people around the fire, ” says Coe. She says the Tent Embassy still exists today because “ we refuse to go away, we refuse to die out ”. Coe’ s aunt, Jenny Munro, also talks to us at the Tent Embassy site in Canberra about her continued involvement in the protest site today.
This episode of The Conversation Weekly is supported by the UK/Australia Season Patrons Board, the British Council and the Australian Government as part of the UK/Australia Season, which centres on the theme Who Are We Now? The season’ s programme reflects on the two countries’ shared history, explores their current relationship, and imagines their future together.
In our second story in this episode, we hear how the pandemic has changed the landscape of economic opportunity for people in their twenties. Since 2001, Young Lives, a study run by the University of Oxford in the UK, has been following the lives of two cohorts of young people born into poverty in India, Peru, Vietnam and Ethiopia.
Until the pandemic, the researchers mostly had a good news story to tell about how life was improving for the younger generations in their study. But the pandemic has set things back – in particular job opportunities for young people. Catherine Porter, director of the Young Lives study, talks us through some of their latest results – and what they reveal about the gender employment gap for young people in the wake of the pandemic. ( Listen from 33m46s)
This episode of The Conversation Weekly was produced by Mend Mariwany and Gemma Ware, with sound design by Eloise Stevens. Reporting from the Aboriginal Tent Embassy in Canberra by Ellen Duffy. Our theme music is by Neeta Sarl. You can find us on Twitter @ TC Audio, on Instagram at theconversationdotcom or via email. You can also sign up to The Conversation’ s free daily email here.
Newsclips in this episode from ABC News, 7News Australia and ABC Australia.
You can listen to The Conversation Weekly via any of the apps listed above, download it directly via our RSS feed, or find out how else to listen here.
The Aboriginal Tent Embassy is a site of cultural and political significance for Lynda-June Coe and members of her family. Some of the Aboriginal activists involved in the 1972 protest are her Elders, Aunties and Uncles.
Bronwyn Carlson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
The Young Lives study currently receives funding from UK Government ( FCDO), Echidna Giving, Packard Foundation, Medical Research Council, NIH. Catherine Porter has previously received funding from ESRC, WIDER, Inter-American Development Bank, the World Bank and British Academy. | business |
Democratizing MRI to advance health equity | Global health IT vendor Siemens Healthineers strongly believes that improving access to magnetic resonance imaging is crucial to advancing health equity.
MRI – used for diagnosing a majority of ailments ranging from heart disease to cancer – is both significantly more expensive than most imaging tools and isn't readily available in all communities. For these reasons, Siemens Healthineers says it is focused on increasing MRI access by:
Partnering with community clinics and health centers to bring MRI closer to the patients who need it most, in both rural and urban areas.
Designing machines that are more affordable for the smaller community hospitals or health centers that provide care in underserved areas.
Pioneering tech innovations to increase access, such as MRIs with decreased field strength – while maintaining image quality – which are more accessible.
Healthcare IT News spoke with Wes Gilson, senior director, magnetic resonance business development at Siemens Healthineers, to discuss MRI and health equity.
Q. How exactly is improving access to magnetic resonance imaging so crucial to advancing health equity?
A. MRI has established itself as one of the most powerful diagnostic tools and is widely used to help determine the absence or presence and extent of a disease or condition.
Some countries lack a single MRI scanner. Some Americans live in communities more than 100 miles away from the nearest MRI. Others struggle with the expense of an MRI. Still others may be too large to undergo an MRI exam on a traditionally narrow-bored system.
Siemens Healthineers is committed to developing MR systems that not only expand MRI's capabilities and efficiency, but also lower the barrier for healthcare providers and communities that previously lacked the means to own and operate an MRI.
Q. You suggest access to MRI can be increased by hospitals and health systems partnering with community clinics and health centers to bring MRI closer to the patients who need it most, in both rural and urban areas. Please elaborate.
A. Numerous hospitals and health systems are expanding their community outreach by creating community clinics, ambulatory surgery centers and other outside-the-hospital care facilities. Not only does this type of outreach more strongly solidify their community presence, but it promises to raise patient compliance and elevate wellness care.
In MRI's case, providing outpatient diagnostic imaging services in the community creates a valuable convenience for patients by reducing the time needed in their schedule and simplifying the overall process.
Moreover, it reduces the hospital's outpatient imaging burden, allowing them to focus more on providing diagnostic services for more critically ill inpatients. The COVID-19 pandemic has further supported the desire by hospitals and patients to undergo outpatient MRI away from hospitals.
Q. You also say access to MRI can be increased by designing machines that are more affordable for the smaller community hospitals or health centers that provide care in underserved areas. How can this be done?
A. Many smaller facilities may not have the same volumes as larger facilities or are in less affluent communities where payment/reimbursement-per-scan challenges them to be profitable or even break even with other systems that have a higher total cost of ownership.
Currently, many of these smaller community hospitals may leverage mobile MRI services to provide support on certain days of the week. Although this may not be ideal for providing the most timely, convenient imaging diagnosis, this service is the best these hospitals can currently support for their communities.
With the advent of MRI systems that have a lower total cost of ownership – construction costs plus product costs plus operating costs – the threshold for owning and operating a scanner becomes more manageable.
Q. And you further suggest access to MRI can be increased by health IT vendors pioneering technology innovations to increase access, such as MRIs with decreased field strength – while maintaining image quality – which are more accessible. Please detail what you mean, and how it would help.
A. As I alluded to, access to MRI may be limited in many ways, including barriers of a geographical ( too far away), economic ( too expensive), physical ( patient too large) and emotional ( claustrophobia) nature. Addressing those access barriers collectively can be quite difficult.
We addressed them by designing a new MRI scanner with an ultra-wide 80cm opening to provide a more open, less claustrophobic experience, and accommodate some of the largest patients who may have been unable to fit in MRI scanners previously.
Beyond addressing these physical and emotional challenges, the new scanner reduces the total cost of ownership, starting with system installation and maintenance costs. This feat was accomplished by reducing the scanner's overall size and eliminating the need for large volumes of liquid helium to maintain the superconductive magnetic field.
To maintain a high level of performance, the system includes the latest advanced hardware ( magnet, gradient, coil) and software ( rapid acquisition, AI-based reconstruction, workflow guidance) technologies, ensuring that it is not just about making the system more accessible, but also about delivering high-quality diagnostic results to ensure equity in care.
Twitter: @ SiwickiHealthIT Email the writer: bsiwicki @ himss.org Healthcare IT News is a HIMSS Media publication. | tech |
Australian Government delivers tech heavy Budget but critics say health system pressures will continue | The Australian Government delivered a 2022-23 Budget on Tuesday focused on cost of living issues, with critics claiming it failed to provide adequate investments in a healthcare system under pressure. But the tech sector has welcomed the Government's commitment to developing the nation's digital economy and reinforcing its cyber resilience.
Within the Budget measures, AU $ 107.2 million ( $ 80 million) is being invested in the Health Delivery Modernisation Program, including new digital services to manage Medicare Complex Care Plans and register Medicare providers.
Services Australia has secured AU $ 96.8 million ( $ 72 million) for the next phase of its upgrade of the payments systems that support the operation of Medicare and the Pharmaceutical Benefits Scheme.
An additional AU $ 213.2 million ( $ 159 million) has been earmarked in annual funding for the Australian Digital Health Agency, while AU $ 32.3 million ( $ 24 million) has been dedicated to the Intergovernmental Agreement on Digital Health with the states and territories, which works towards interoperability within the nation's digital health infrastructure, and delivering improvements to health system quality, safety, accountability, transparency and patient-centred healthcare.
To continue the operation of the data and digital systems underpinning the COVID-19 vaccine rollout, including those enabling the ordering and distribution of vaccines and vaccination appointment booking platforms, AU $ 66.7 million ( $ 50 million) has been committed.
Almost AU $ 3 million ( $ 2.24 million) over four years will be directed towards migrating the Australian Institute of Health and Welfare’ s data to more secure cloud-based services and off-site data centres, while AU $ 648.6 million ( $ 485 million) has been contributed towards mental health services, including AU $ 63.6 million ( $ 47.6 million) on digital tools.
Following the royal commission into aged care, the government will invest AU $ 345.7 million ( $ 259 million) over four years towards improving medication management in residential aged care facilities through on-site pharmacists and community pharmacy services – a measure designed to complement ongoing implementation of digital capabilities.
In an effort to drive the use of genomics in Australian healthcare, more than AU $ 28 million ( $ 21 million) will be invested over four years to establish Genomics Australia. A further AU $ 15 million ( $ 11 million) will go towards a cancer genomics laboratory at the Australian Cancer Research Foundation Cancer Genome Facility.
Permanent universal telehealth is also now entrenched in Australia's health system, with the Government providing an additional AU $ 512 million ( $ 383 million).
The Royal Australian College of General Practitioners ( RACGP) welcomed the continued commitment to telehealth but warned the Budget failed to address the fall-out of the COVID-19 pandemic and future challenges of a fatigued health system.
`` In our submission to the draft [ Primary Health Care ] 10 Year Plan, we stressed that high-quality care offered by GPs is at risk if substantial reform does not take place. Reform without proper investment is not worth the paper it’ s written on, '' RACGP President Dr Karen Price said.
`` General practice is under enormous pressure delivering COVID-19 vaccines and soon we will be doing the same for influenza vaccines. We are helping patients who have delayed or avoided care during the pandemic, including those with mental health issues amidst a looming mental health crisis in Australia. ''
The Australian Medical Association ( AMA) President Dr Omar Khorshid said the Budget's Medicare and hospital funding was `` little more '' than the usual recurrent spending and planned growth.
`` The Budget re-states the Commonwealth will only meet 45 per cent of usual hospital costs, and that the 6.5 per cent cap on hospital funding growth will remain, ” Dr Khorshid said.
`` Yet hospital Emergency Departments are full, ambulances are ramping, and the AMA estimates the waiting list for essential ( elective) surgery has blown out by a further 190,000 surgeries with COVID-19 elective surgery pauses, on top of the existing wait lists. ''
The Medical Software Industry Association said the government's funding to aged care can be considerably enhanced by digital health technologies.
`` The digital health sector is an inherent part of healthcare and innovations available now can revolutionise the aged care sector, '' MSIA President Rob Best said.
`` Technologies offer considerable potential in terms of improving care outcomes, efficiencies and costs by enabling coordinated care and health information sharing. ''
The technology sector fared well, with the Federal Government contributing another AU $ 130.1 million ( $ 97 million) over the next four years to help realise its ambition of making Australia a top ten data and digital economy by 2030.
The Australian Signals Directorate will receive AU $ 9.9 billion ( $ 7.4 million) over the next decade to boost the nation's cybersecurity with a new resilience, effects, defence, space, intelligence, cyber and enablers package ( called `` REDSPICE ''). The `` largest ever investment in Australia’ s intelligence and cyber capabilities '' will see AI and smart technologies enhance the nation's capabilities, and lead to the cyber agency doubling in size to almost 4000 staff over the next ten years. Cybercrime is estimated to have cost Australia up to AU $ 42 billion ( $ 31 million) last financial year.
In an attempt to accelerate digital adoption, the Government also revealed a `` technology investment boost '' that will allow small businesses to deduct a further 20 per cent from the cost of cloud services and cybersecurity systems. | tech |
Government says public services won't be affected by more permanent remote working | Michael McGrath, the public expenditure minister: 'We have been hugely impressed with the commitment of our civil servants. They have maintained the difficult and challenging circumstances of already high quality of service to the general public. ' Picture: Gareth Chaney/Collins
Delivery of public services will not be adversely affected by allowing civil servants to work remotely, the Government has said.
The Blended Working Framework published by Michael McGrath, the public expenditure minister, will allow civil servants to work at least one day a week remotely on a permanent basis.
Mr McGrath said the experience of the Covid-19 pandemic “ in the round ” of staff working from home was positive, despite criticisms around delays in services like the passport office. | general |
Convalescent plasma can be effective early COVID-19 therapy, study finds -- ScienceDaily | The research showed that high-titer ( antibody-rich) COVID convalescent plasma -- when administered to COVID-19 outpatients within nine days after testing positive -- reduced the need for hospitalization for more than half of the study's predominantly unvaccinated outpatients. The U.S. Food and Drug Administration ( FDA) currently authorizes this plasma as a treatment option for outpatients with immunocompromising diseases or receiving immunocompromising medications, and for all patients hospitalized with early-stage COVID-19.
The findings were first presented in a preprint posted to MedRxiv on Dec. 21, 2021. Details of the study, including authors and funding sources, may be found in the Johns Hopkins news release issued at that time ( https: //www.hopkinsmedicine.org/news/newsroom/news-releases/early-use-of-convalescent-plasma-may-help-outpatients-with-covid-19-avoid-hospitalization).
`` Based on our findings and conclusions -- which are now validated through the peer-review process -- we encourage health care professionals to keep SARS-CoV-2 antibody-rich blood plasma available in their blood banks as part of the treatment arsenal against early-stage COVID-19, '' says study co-lead author David Sullivan, M.D., professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health with a joint appointment in infectious diseases at the Johns Hopkins University School of Medicine.
`` We believe that the best role for convalescent plasma is extending its use to early outpatient treatment when other therapies, such as monoclonal antibodies or drugs, are either not readily available -- as in low- and middle-income countries -- or ineffective, as with SARS-CoV-2 variants that are resistant to certain monoclonal antibodies, '' Sullivan adds.
In the outpatient early-treatment study conducted between June 2020 and October 2021, the researchers provided 1,181 randomized patients with one dose each of either polyclonal high-titer convalescent plasma ( containing a concentrated mixture of antibodies specific to SARS-CoV-2) or placebo control plasma ( with no SARS-CoV-2 antibodies). The patients were 18 and older, and had tested positive for SARS-CoV-2 within eight days prior to transfusion. A successful therapy was defined as a patient not requiring hospitalization within 28 days after plasma transfusion.
The study found that 17 patients out of 592 ( 2.9%) who received the convalescent plasma required hospitalization within 28 days of their transfusion, compared with 37 out of 589 ( 6.3%) who received placebo control plasma. This translated to a relative risk reduction for hospitalization of 54%.
Timing of the convalescent plasma transfusion also is critical: `` The earlier the better, '' the researchers say.
`` Based on the findings of an analysis in the new paper that wasn't available when the preprint was posted, we found that if convalescent plasma is given within five days after diagnosis, the effectiveness at reducing hospitalization approximated 80%, '' says Sullivan.
`` We concluded that these results strongly support high-titer SARS-CoV-2 convalescent plasma as an effective early treatment for COVID-19 with advantages such as low cost, wide availability and rapid resilience to the virus's evolving variants, '' says study co-lead author Kelly Gebo, M.D., M.P.H., professor of medicine at the Johns Hopkins University School of Medicine.
The next step, the researchers say, is to make convalescent plasma for the outpatient treatment of COVID-19 easier to use, more efficiently administered and more accessible to those who might need it. As part of that effort, they have provided clinicians with a guide for implementing a plasma transfusion center for outpatients with COVID-19, including logistical, staffing and blood banking requirements. The guide appears in a paper published March 29, 2022, in the journal Transfusion.
The team also continues to seek more understanding of what else convalescent plasma can do for outpatients with COVID-19. A soon-to-be published study will look at the ability of plasma to neutralize SARS-CoV-2 variants, including delta and omicron, despite no previous donor exposure to those viruses.
Since the study findings were first announced last December, there have been three developments supporting the use of convalescent plasma for early-stage COVID-19:
`` These recent acknowledgements of high-titer convalescent plasma's benefit in treating early-stage COVID-19 -- in conjunction with our peer-reviewed findings and our new guide for more effective administration of the treatment -- provide clinicians with an additional option for outpatients, '' Gebo says. | science |
Government hails ‘ major shift’ on remote working for civil servants | The move to ‘ blended working’ will benefit around 40,000 civil servants. Picture: Joe Giddens/PA
Tens of thousands of civil servants will now be able to work remotely at least some of the time.
The Government has hailed the move as a “ major shift ” in working arrangements for around 40,000 civil servants, which will see officials able to work from home at least 20% of the time.
It also partly formalises many of the remote-working reforms ushered in overnight by the Covid-19 pandemic two years ago.
Launching the policy on Thursday, Michael McGrath, the Minister for Public Expenditure and Reform, said the plan “ marks the formal beginning of a new way of working in the civil service ”.
The plan envisages blended working arrangements in place before the summer, with civil servants offered the chance to work both from home and from the office.
However, civil servants will have to work from somewhere in Ireland.
Mr McGrath said that he anticipated some civil servants working from home more than 20% of the time in the future, but ruled out a 100% shift to remote working.
“ As a general rule of thumb, we don’ t envisage that anyone will be working 100% from home.
“ Because it is important there would be collaboration in the place of work.
“ We all know that younger and new members of staff, in particular, to really get the benefits of collaboration, ” he said.
Mr McGrath confirmed that there is no additional money for civil servants as part of the plan who choose to work from home. | general |
Sri Lanka teeters on economic edge, from pandemic-fueled financial crisis and Ukraine war spillovers | An unprecedented economic crisis is unfolding in Sri Lanka. And while the country’ s problems have been brewing for years, spillovers from the crisis in Ukraine have sent the island nation over the edge.
The Sri Lankan rupee has plunged to a record low against the U.S. dollar. Annual inflation is in the double digits. Import controls are in effect. And the country is teetering on the edge of default.
As a result, power blackouts are routine. Fuel, food and medicine – most of which are imported – are scarce, and rising prices are putting what remains out of reach for many Sri Lankans. Even printing paper is hard to come by, forcing schools to cancel exams. The problems have sparked the biggest protests seen here in years. Troops have been sent in to quell them.
Sri Lanka is now turning to foreign assistance for help, including its two biggest trading partners. China is considering offering US $ 2.5 billion more over the $ 2.8 billion already extended, and India has put up $ 2.4 billion. And President Gotabaya Rajapaksa’ s government is currently in negotiations with the International Monetary Fund and the World Bank for a bigger aid package – something he had previously resisted, to avoid the often onerous terms they require.
As an economist and former official at the Central Bank of Sri Lanka, I saw firsthand many of the policies that led to the current crisis. And now the economic, financial and political stability of Asia’ s oldest democracy are all at risk if the government doesn’ t find a sustainable way out.
Sri Lanka, which gained its independence from Britain in 1948, only recently emerged from a deadly and costly 26-year civil war.
The war was fought between the government military of this majority Sinhalese country and armed separatists from the Tamil-speaking minority. Civilians and civil properties were frequent targets.
Toward the end of the war, in 2006, the government tried to jumpstart growth by borrowing heavily and attracting foreign capital by propping up the rupee. In the short-term, the strategy worked. The economy boomed, causing the per-capita gross domestic product to surge from $ 1,436 in 2006 to $ 3,819 in 2014 – vaulting Sri Lanka past Ukraine, the Philippines and Indonesia. This lifted 1.6 million people out of poverty – 8.5% of the population – and gave rise to a large middle class. By 2019, Sri Lanka ascended to the ranks of the World Bank’ s “ upper middle-income ” countries.
The designation lasted only for a year, however, because all that growth came at a cost. Sri Lanka’ s external debt tripled from 2006 to 2012, pushing total public debt to 119% of GDP.
Those policies were suspended for a time in 2015, which stabilized the economy at a lower rate of growth, but the debt continued to accumulate.
Then the COVID-19 pandemic hit.
Tourists, who spent $ 5.6 billion in 2018 and played a big role in balancing Sri Lanka’ s $ 10 billion trade deficit, disappeared virtually overnight.
This dealt a massive blow to the economy, especially considering a large tax cut the previous year depleted government coffers. Simply paying interest on that large debt took up 72% of government revenue in 2020, requiring the central bank to print more cash to avoid default, thus fueling inflation.
Fortunately for the government and its citizens, Sri Lankans overseas continued to send home a vital lifeline of remittances, or about $ 7 billion a year.
But in 2021, as many economists and analysts urged Sri Lanka to seek international aid, the central bank instead focused on borrowing from its neighbors, maintaining the value of the rupee and restricting imports.
The export controls caused shortages of essential goods like cooking gas and milk, and defending the currency drained Sri Lanka’ s foreign reserves. Moreover, remittances began to drop as the black market value of the rupee fell, leading people to avoid converting dollars to rupees at the official rate or by official channels. Annual inflation has been estimated at as much as 55%, compared with the official rate of 14%.
By March 2022, reverberations from the war in Ukraine, which drove up international prices of oil, wheat and many other commodities, finally forced the government to change course. Beyond the effect on the cost of imported goods, the war also further threatens Sri Lanka’ s tourism industry as flights to Moscow are now suspended. Before the war, Russians frequently made up the biggest share of Sri Lankan tourists, with Ukrainians not far behind.
Sri Lankan authorities had few other options than to allow the rupee to depreciate – which is expected to save billions of dollars a year – and seek IMF assistance. Sri Lanka will likely also have to restructure its large debt load – by asking foreign bondholders to accept less than than 100% of the value of their investments – to make it more sustainable.
The strategy may be working, but the cost to Sri Lankans will be high for a long time.
Over 350 “ non-essential ” items are now banned for import, including milk, oranges and household appliances.
And the limited supply of goods that remain are getting more expensive every day. The price of cooking gas, for example, is almost three times higher than it was just five months ago.
Securing loans from the IMF and the World Bank, along with short-term credit from China and India, may stabilize Sri Lanka’ s economic and financial situation. But with protests growing and the austerity measures demanded by the lenders likely to prove unpopular, the government may find it hard to survive for long.
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Rapid Testing Program for Students and Staff at Schools | Students, teachers and staff in all K-12 schools will be provided with COVID-19 rapid self-test kits to use at home. These test kits are being delivered to schools throughout the province. This testing program is another way to help reduce the spread of COVID-19 in schools.
The process for getting your tests will be specific to each school, so keep an eye out for an email from your administrator through PowerSchool or by email.
When you receive the tests, keep them in a safe place and out of reach from children and pets.
You may share your rapid tests with others who require testing if you have extra kits available at home ( for example, friends and family members).
If you start having symptoms of COVID-19, do not go to school. Test yourself on the first day you are having symptoms:
1. What is a rapid COVID-19 self-test?
A rapid COVID-19 self-test can detect COVID-19 in about 10-15 minutes. This test can be used at home to detect COVID-19. If you test positive on a rapid test, you have COVID-19. Please review the guidance for positive cases for more information.
2.Is participation in the rapid COVID-19 self-testing program mandatory?
While participation in this program is not mandatory, it is strongly encouraged by public health officials.
3. My child is fully vaccinated, should they still participate in this program?
Participation in the rapid COVID-19 self-testing program is strongly encouraged.
4. How do I use a rapid COVID-19 self-testing kit?
Instructions will be provided in the kit you are given. The test is easy to use and only a shallow nasal swab ( inserting 2cm) is required to collect the sample. Results can be available in as little as 10-15 minutes.
5. When should I test my child using a rapid COVID-19 self-test?
The tests can be used if your child has mild symptoms ( e.g. a runny nose).
6. When is it not appropriate to use a rapid COVID-19 test?
7. My child was recently vaccinated for COVID-19 and is experiencing symptoms of COVID-19, should I use a rapid COVID-19 self-test?
You may experience symptoms after receiving the COVID-19 vaccine. There is no need to use a rapid COVID-19 self-test unless symptoms persist longer than two days.
8. Can I use the rapid COVID-19 self-tests on the adults in my household?
Yes. You may share your rapid tests with others who require testing if you have extra kits available at home ( for example, friends and family members). If you are unsure of your testing requirements, please complete the online COVID-19 Assessment and Test Reporting Tool for direction.
9. Can I test my child with the rapid COVID-19 self-test if they don’ t have symptoms?
The rapid self-tests are intended to be used in school-aged children with mild symptoms. If your child is a close contact of someone who has tested positive for COVID-19 but does not have any symptoms, review the Close Contacts Flowchart for guidance.
10. Can I use the rapid COVID-19 self-tests on my child who is under two years old?
The rapid self-test kits have not been approved for use in children under two years of age. Symptomatic children in this age group can book a PCR test using the online COVID Assessment and Referral App or by contacting 1-833-951-3859.
11. What happens if my child’ s test is negative?
If your child has had two negative tests taken 72 hours apart and their symptoms have improved with no fever for at least 24 hours ( without fever reducing medication such as Tylenol, Tempra, Advil, or Motrin), they can return to school. A single negative test result is not completely reliable. This is why the rapid self-testing program requires you to do more than one test.
12. Why does my child need to complete more than one rapid COVID-19 self-test before they can return to school?
A single negative test result is not completely reliable. Performing multiple tests increases the chance that an individual will be tested when their viral loads are highest.
13. My child does not have symptoms of COVID-19 but tested positive on a rapid self-test, what should I do?
Your child has COVID-19. You do not need to book a PCR test. Do not complete any more rapid tests. Please review the guidance for positive cases for advice on self-isolation and contact notification.
14. My child has tested negative using a rapid COVID-19 self test but then had a positive PCR test, what now?
Your child has COVID-19. Do not complete any additional testing. Please review the guidance for positive cases for advice on self-isolation and contact notification.
15. My child is a close contact of someone who tested positive for COVID-19, can they be tested with a rapid COVID-19 self-test?
Rapid tests may be used if you are a close contact requiring testing. Please review the Close Contacts Flowchart for specific guidance regarding testing and isolation.
16. My child has tested positive twice using a rapid COVID-19 self-test but then had a negative third rapid COVID-19 self-test?
Your child has COVID-19. Do not complete any additional testing. Please review the guidance for positive cases for advice on self-isolation and contact notification.
17. What happens if my child’ s test is positive?
A positive rapid self-test result means your child has COVID-19 and must self-isolate. You do not need to report this to your child’ s school. Your child should not be re-tested with another rapid COVID-19 self-test and you should not book a PCR test. Please review the guidance for positive cases for advice on self-isolation and contact notification.
18. Where can I get more rapid self-tests?
You will get more rapid self-tests through your school.
19. How do I safely dispose of my used rapid COVID-19 self-test?
You can safely dispose used tests in your household garbage.
20. If my child is symptomatic and I do not have any rapid COVID-19 self-test kits at home, can I book a PCR testing appointment?
If your child is symptomatic and you do not have access to a rapid self-test, please complete the COVID Assessment and Referral Form or call 1-833-951-3859 to determine if you need lab-based testing.
21. My child’ s rapid COVID-19 self-tests are negative but they have symptoms of COVID-19, what should I do?
If your child has had two negative tests taken 72 hours apart and their symptoms have improved with no fever for at least 24 hours ( without fever reducing medication such as Tylenol, Tempra, Advil, or Motrin), they can return to school. If they still have a fever or their symptoms remain, they should stay at home until 24 hours after their fever is gone AND their symptoms improve.
22. If I see pink shading on the strip bordering the black label, is this a positive result? ( Quickvue tests only) | general |
NIH experts discuss controlling COVID-19 in commentary on herd immunity -- ScienceDaily | The general concept of herd immunity implies that transmission of an infectious agent can be blunted, except for sporadic outbreaks, because a certain proportion of the population is already protected through vaccination or prior infection. The authors explain how the scientific understanding of herd immunity and its applications to various diseases have evolved over time. High levels of herd immunity have enabled the United States to largely control polio and measles -- two diseases caused by viruses that have not undergone significant evolution. However, the authors note, the benefits of achieving herd immunity thresholds have been less successful with respiratory viruses such as influenza, which continually mutate.
Dr. Fauci and his colleagues write that achieving classical herd immunity against SARS-CoV-2 is unlikely, due to a combination of factors that include features of the virus as well as current societal dynamics. These include the virus ' ability to continually mutate to new variants; asymptomatic virus transmission, which complicates public health control strategies; the inability of prior infection or vaccination to provide durable protection against reinfection; suboptimal vaccination coverage; and adherence to non-pharmacologic interventions.
However, the authors note, controlling COVID-19 without major disruptions to society is now achievable because of widespread background immunity via prior infection or vaccination, booster shots, antiviral drugs, monoclonal antibody therapies and widely available diagnostic tests. Research to develop pan-coronavirus vaccines, which could protect against multiple coronaviruses or at least multiple SARS-CoV-2 variants, remains crucial.
`` Living with COVID is best considered not as reaching a numerical threshold of immunity, but as optimizing population protection without prohibitive restrictions on our daily lives, '' the authors conclude. | science |
Salmon Scotland reveals three challenges hurting Scottish producers | The Scottish salmon sector is wrestling with three challenges that are holding back the industry, as the global impact of the Russia-Ukraine conflict, post-Brexit changes and regulatory issues combine to impact producers.
Speaking exclusively to SalmonBusiness, Salmon Scotland Chief Executive Tavish Scott warned that the regional industry is facing a mixture of pressures, as rising fuel prices, around £3 million of post-Brexit costs per year and burdensome red tape cut into the financial resources of producers.
Rising production costs With 61 percent of global Scottish salmon exports being delivered to the EU, the vast majority of producers in Scotland transport their fish via road. So, rising fuel costs increase the financial pressure on producers seeking to transport their goods in lorries to the continent. Similarly, the cost of raw materials has risen due to the conflict between Russia and Ukraine, causing more headaches for producers.
While Scott states that Scotland only exported a small portion of salmon to Ukraine and hasn’ t exported salmon to Russia since the 2014 invasion of Ukraine, Scottish producers did source “ soya, rapeseed oil and wheat from Ukraine, ” which now won’ t be available for the foreseeable future.
With prices rising, Scott noted that some costs are being absorbed by companies, with the freight industry and producing companies taking a hit of the rising production costs but on the other side some costs are being passed on to consumers, forcing salmon to be more costly.
Other entities have experienced similar issues, with the CEO of Ocean Freight Specialist Ocean Supreme, Botholf Stolt-Nielsen, raising concerns about the growing cost of air freight, as the war in Ukraine has doubled the cost of shipping salmon. “ The question is how long this will be, whether it will be a permanent situation or whether it will be for a period, ” Botholf Stolt-Nielsen told NRK Møre og Romsdal.
Read also: Scottish salmon to fill trade void after Russian exports are hit by sanctions over Ukraine
Post-Brexit impact Even without the conflict in Europe, Scott warned that the salmon industry in Scotland was already facing the “ thick end of £3 million of extra costs per annum because of the paper work and the bureaucracy ” that Scottish companies were hit with.
In a further warning, Scott highlighted how “ an additional 12% of costs ” are set to be laid on Scottish salmon producers by food standards “ for the work they do at the logistics hubs in Scotland prior to the salmon being exported. ”
To help protect Scottish industries, Scott called on the UK government to cover the post-Brexit costs due to the assurance that had been made of a digital export system that would’ ve eliminated a lot of the extra financial burden imposed through the bureaucracy. Salmon Scotland is set to meet with ministers in Scotland to discuss the situation in the coming days but, as of yet, no timescale has been provided on when the situation is expected to improve.
Regulatory pressures Post-Brexit rules aren’ t the only bureaucracy that Scott warned the industry is being forced to struggle with. “ There’ s no doubt, and the Griggs reports demonstrates this, that the regulatory environment in Scotland at the moment is not conducive to the sustainable growth of the sector, ” Scott stated.
The Griggs report, an independent review of the current regulatory framework for Scottish aquaculture, laid out how the individuals and organisations spoken to during his investigation found the region’ s “ current regulatory system for aquaculture is not fit for purpose. ”
Scott agreed with this position, stating that, “ instead of having four regulators acting independently of each other and hardly speaking, ” Scottish authorities should stick them “ under one umbrella where everone knows where the buck stops. ”
The current process is “ ridiculously long ” and time consuming, limiting the ability of salmon producers to grow at a comparable rate to their Scandinavian competitors, Scott feared. Despite there seemingly being political support for the sector and its continued development, due to its importance to Scotland, Scott claimed “ bureaucratic inertia within regulators ” has slowed any progress or improvements to the current system.
Growing Scottish market Despite the challenges facing the Scottish salmon industry, Scott highlighted the positive situation for the region, as export statistics show that there is a “ rising trend for demand in the European marketplace, norther America and indeed in other emerging markets, such as China and Japan. ”
“ We’ re selling more salmon into France now than we did before Brexit and those numbers are encouraging also in most of the other European markets, ” Scott said, citing how he believed people are looking for “ quality protein ” which is provided by Scottish salmon.
Salmon Scotland is “ working very closely with Scottish development international and the UK department of trade ” to promote salmon in the longer haul markets, having had a “ two year delay ” to the industry’ s growth due to the dual hit of Brexit and the Covid pandemic.
post @ salmonbusiness.com | general |
Salesforce Users Tap AI, Analytics for Omnichannel Results | U.S. enterprises are flocking to Salesforce-based artificial intelligence ( AI) and deep analytics solutions to build omnichannel customer and employee experiences, according to a new research report published by Information Services Group ( ISG), a leading global technology research and advisory firm.
“ Salesforce and solutions like it have been a lifeline for U.S. enterprises forced to change the way they reach customers during the COVID-19 pandemic ”
The 2022 ISG Provider Lens Salesforce Ecosystem Partners report for the U.S. finds solutions that include Salesforce’ s Tableau analytics and Einstein AI platforms allow organizations to handle increasing interactions across multiple channels. This year’ s report introduces a new quadrant, Implementation Services for Analytics Solutions on Salesforce, that examines the relatively new and growing market for analytics implementations by Salesforce service providers.
“ Salesforce and solutions like it have been a lifeline for U.S. enterprises forced to change the way they reach customers during the COVID-19 pandemic, ” said Bill Huber, ISG partner, Digital Platforms and Solutions. “ Enabling omnichannel experiences with AI and analytics is just one of the new ways these solutions have come into play. ”
The report includes tips on implementing Salesforce Marketing Cloud solutions for enterprises that are returning to work after the pandemic while still optimizing digital-first employee and customer experiences. Enterprises are focused on staying flexible, adopting automation to handle growing transaction volumes and using analytics and AI to deliver more personalized experiences.
“ By implementing data analytics and AI tools, companies can create a human touch to deliver new levels of customer experience, ” said Jan Erik Aase, partner and global leader, ISG Provider Lens Research. “ Direct, one-on-one communication, at scale and across multiple channels, can increase engagement and revenue. ”
The report provides similar insights on a broad range of other Salesforce-related services for organizations of all sizes, including managed application services, multi-cloud implementation and integration for large enterprises, and implementation of Salesforce core clouds for the midmarket. The report finds most U.S. companies take a hybrid cloud approach and prefer service providers with strong integration capabilities and a global presence, while some midsize customers embrace a purely agile methodology.
The 2022 ISG Provider Lens Salesforce Ecosystem Partners report for the U.S. evaluates the capabilities of 42 providers across six quadrants: Multi-Cloud Implementation & Integration Services for Large Enterprises, Implementation Services for Core Clouds Midmarket, Implementation Services for Marketing Cloud Midmarket, Managed Application Services for Large Enterprises, Managed Application Services for Midmarket and Implementation Services for Analytics Solutions on Salesforce.
The report names Persistent Systems as a Leader in four quadrants. It names HCL, Infosys, Silverline, Traction on Demand and Wipro as Leaders in three quadrants each. Accenture, Birlasoft, Capgemini, Coastal Cloud, Cognizant, Hexaware, Mindtree, TCS and Tech Mahindra are named as Leaders in two quadrants each. Brillio, Customertimes, Deloitte Digital, Dentsu, LTI and Slalom are named as Leaders in one quadrant each. | tech |
Dangerous Trend: Growing Number of Pills Containing Fentanyl Seized by Law Enforcement | NIH-supported research highlights growing, dangerous trend, particularly for people new to drug use.
Law enforcement seizures of pills containing illicit fentanyl increased dramatically between January 2018 and December 2021, according to a new study. The number of individual pills seized by law enforcement increased nearly 50-fold from the first quarter of 2018 to the last quarter of 2021 and the proportion of pills to total seizures more than doubled, with pills representing over a quarter of illicit fentanyl seizures by the end of 2021. The study also found an increase in the number of fentanyl-containing powder seizures during this time.
This study was published today in Drug and Alcohol Dependence and funded by the National Institute on Drug Abuse ( NIDA), part of the National Institutes of Health. According to the most recent Centers for Disease Control and Prevention data, the United States hit a record high in the number of overdose deaths ever recorded, estimating that nearly 106,000 people died from drug overdoses in the 12-month period ending in October 2021. This rise is largely driven by illicit fentanyl and other synthetic opioids.
Illicit fentanyl is highly potent, cheaply made and easily transported, making it a profitable narcotic. While people may seek out illicit fentanyl intentionally, many people are not aware that the drug they are using – including heroin, cocaine, methamphetamine, or benzodiazepines – may actually be fentanyl, or has been adulterated or contaminated with fentanyl. Because fentanyl is about 50 times more potent than heroin and a lethal dose may be as small as two milligrams, using a drug that has been laced with fentanyl can greatly increase overdose risk.
Number of pills containing fentanyl seized by law enforcement in the United States, 2018-2021. Credit: National Institute on Drug Abuse, NIH
“ An increase in illicit pills containing fentanyl points to a new and increasingly dangerous period in the United States, ” said NIDA Director Nora D. Volkow, M.D. “ Pills are often taken or snorted by people who are more naïve to drug use, and who have lower tolerances. When a pill is contaminated with fentanyl, as is now often the case, poisoning can easily occur. ”
Illicitly manufactured powder fentanyl has been a known adulterant in drugs since 2013, but the extent that fentanyl is found in counterfeit pills has been largely unknown. To address this question, a team led by Joseph J. Palamar, Ph.D., M.P.H., associate professor at the NYU Grossman School of Medicine and co-investigator on the NIDA-funded National Drug Early Warning System ( NDEWS), analyzed data on drug seizures by law enforcement. The data were collected between January of 2018 and December of 2021 from the High Intensity Drug Trafficking Areas ( HIDTA) program, a grant program aimed at reducing drug trafficking and misuse administered by the Office of National Drug Control Policy in which the Drug Enforcement Administration and the CDC play an active role.
Comparing data from the first quarter of 2018 with the last quarter of 2021, the team found that the number of seizures of pills containing fentanyl increased from 68 to 635, and the total number of individual pills seized by law enforcement increased from 42,202 to 2,089,186. Seizures of powder containing fentanyl also increased from 424 to 1,539, and the total weight of powder seized increased from 298.2 kg to 2,416.0 kg.
Unlike most survey data and surveillance systems which can be lagged for a year or more, HIDTA data are made available quarterly, allowing evaluation in almost real time. HIDTA also distinguish between the presence of fentanyl in pill or powder form. Analyzing these data can therefore help identify trends in availability of illicit substances and act as a type of early warning system to shift public health education or interventional resources more quickly.
HIDTA data does not differentiate between fentanyl and its analogs, nor estimate the amount of fentanyl present in seized substances; however, given the small amount necessary for an overdose, the authors note that the presence of any fentanyl is an important indicator of overdose risk. People who purchase counterfeit drugs, such as illicit oxycodone, hydrocodone, or benzodiazepines may be at risk for unintentional exposure to fentanyl, which is associated with increased risk of overdose death. Further, people who use these types of pills are less likely to have a tolerance built to opioids, and when coupled with the sedative effects of non-fentanyl opioids or benzodiazepines, may further increase risk of overdose and death.
“ For the first time we can see this rapid rise in pills adulterated with fentanyl, which raises red flags for increasing risk of harm in a population that is possibly less experienced with opioids, ” said Dr. Palamar. “ We absolutely need more harm reduction strategies, such as naloxone distribution and fentanyl test strips, as well as widespread education about the risk of pills that are not coming from a pharmacy. The immediate message here is that pills illegally obtained can contain fentanyl. ”
The researchers emphasize that drug seizure rates are not direct measures of actual drug availability. However, the increase in fentanyl-related drug seizures coincides with increasing synthetic opioid-related overdose death rates. These data also corroborate data from the DEA National Forensic Laboratory Information System showing a steady increase in fentanyl seizures in recent years, even across the earlier parts of the COVID-19 pandemic.
“ To address the overdose crisis, you need real-time, high-quality drug surveillance data to inform the public health response, ” said Linda B. Cottler, Ph.D., M.P.H, principal investigator of NDEWS, and last author on the paper. “ Through collecting and sharing data on drug use trends as we do through our NIDA-funded NDEWS, we aim to guide strategies to curb the overdose crisis of today, while also keeping our eye on the horizon to prepare for the problems of tomorrow. ”
Reference: “ Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021 ” by Joseph J. Palamar, Daniel Ciccarone, Caroline Rutherford, Katherine M. Keyes, Thomas H. Carr and Linda B. Cottler, 31 March 2022, Drug and Alcohol Dependence. DOI: 10.1016/j.drugalcdep.2022.109398 | tech |
Boots sales jump despite Omicron as owner considers sale | Boots has revealed a jump in sales despite pressure from the spread of the Omicron variant of coronavirus as the potential sale process of the pharmacy chain rumbles on.
US parent company Walgreens Boots Alliance confirmed that a “ strategic review ” of the UK business is in progress, amid speculation that initial takeover offers have been made for the company in recent weeks.
It is understood that US private equity firms Apollo and Sycamore partners are among firms to have placed non-binding offers.
It comes as Boots continued its pandemic recovery, reporting a jump in sales driven by improving high street footfall. | general |
Immune System Master Class News and Research | In early 2020, when SARS-CoV-2 spread around the globe, national, regional and local politicians and health authorities held daily press conferences to explain the importance of R0 ( a mathematical indicator of a disease’ s contagiousness pronounced “ R naught ”); media pundits debated the precise definition of “ herd immunity ”; and social media ads for face coverings promoted the concept of “ viral load. ” Never, perhaps, had the general public learned so much so quickly about the human immune system.
Since COVID’ s discovery, scientists have raced to determine how it undermines the body’ s natural defenses to wreak havoc on the lungs and other organs. Thankfully, vaccines using a new mechanism of action based on decades of immune research were developed in under a year and proved to be powerful protection against the virus. Because of its impressive success, mRNA vaccine technology is already being tested against a host of other afflictions from malaria to tuberculosis.
Researchers are making other immunological strides against many infectious diseases as well. Impressive advances have been reported against HIV, including new ways to weaken the virus. A vaccine based on a group of viruses typically excreted in feces might prevent type 1 diabetes. And a controversial line of research posits the intriguing possibility that a vaccination for one disease may provide protection against others.
Harnessing a person’ s own immune system to fight disease is revolutionizing cancer therapy. The past decade has seen remarkable progress in manipulating key immune players such as CAR T cells and checkpoint inhibitors to treat nonsolid cancers. Promising new trials are training this therapy against solid tumors and pairing it with individual patient protein analysis to increase the chances that treatments will work.
A nagging mystery of the human immune system is why it sometimes turns on people’ s own, otherwise healthy bodies. Women account for nearly 80 percent of cases of autoimmune disorders, potentially implicating reproductive hormones, X chromosomes and gut microbiota. An answer to this conundrum most likely doesn’ t exist in one discrete line of inquiry. Instead it will require enormous data sets, drawn from genetic studies to microbiome assessments to environmental surveys.
Once thought to be independent immunological operators, the brain and the immune system now appear to work in close conjunction, protecting each other through intricate communication and keeping a log of previous pathological invaders. Sickness or health does depend on how well we eat, sleep and move, adding more urgency for the need to ensure all humans have access to quality nutrition and safe communities.
The coronavirus pandemic gave unprecedented urgency to immune research, revealing both the extraordinary defense system our bodies evolved to survive and the ferocity of viruses, bacteria and environmental stressors that threaten us. In a time plagued by not only a deadly pathogen but also misinformation and uncertainty, the science of the immune system has never been more sought after or necessary. | science |
Get Joy Builds First Metaverse Dog Park to Expand Commitment to the Health and Happiness of Dogs Everywhere | Get Joy, a DTC dog wellness brand founded by former Facebook executive Tom Arrix, announces the establishment of the first-ever dog park in the metaverse. Get Joy wants communities to recognize and respect their evolving dog populations and invest in their wellness and quality of life by ensuring dogs have equitable recreational space to call their own – whether that is in future, growing communities like the metaverse or communities in real life.
The virtual space, named Get Joy Dog Zone, will be located in the virtual world of Decentraland. Get Joy Dog Zone is currently under development and is being designed in partnership with M3taverse.io, the first web3 engagement infrastructure for people and brands. The park will open its gates in April of 2022.
“ Get Joy aims to increase dog joy through three things: nutrition, the cornerstone of what we do, educating pet parents on how to be the best dog parents they can be, and now, expanding our commitment to establish and improve the places dogs can go, ” said Get Joy Founder and CEO, Tom Arrix. “ We are turning to the metaverse to dramatize the fact that in most real-life communities, there is an imbalance between the size of the dog community and the available recreational space that exists for those animals. ”
“ The evolving vision for the metaverse will continue to attract pioneering brands willing to find new ways to engage communities and lifestyles that transcend real and digital spaces. Decentraland creates a fascinating opportunity to introduce a new world for pet owners that promotes the wellness of our furry companions, ” said Tomas Siedleczka, Founder and CEO of M3taverse.io. “ Get Joy will be the first to support dog wellness for owners with a destination that allows them to learn, connect, and participate in gamified events, bridging real life and digital life with their dog. ”
Communities everywhere, including the metaverse, are growing and changing. Dogs, whether a 3D avatar of the real-life counterpart or a dog acquired IRL during the COVID-19 pandemic, are members of communities and deserving of consideration especially as change occurs. This effort marks the beginning of a national movement by Get Joy to ensure the dog population is recognized and supported in every community and that dogs have the space they need to live a healthy and happy life.
“ Pets are living, social beings just like humans. Dogs need proper nutrition for the right amount of energy for exercise, healthy fur and coat quality, ” said Dr. Kendra Pope, a board-certified veterinary oncologist. “ Exercise, socialization and play are also critical to a dog’ s quality of life and overall health. I’ m intrigued by the idea of tying together connectivity in person and in the metaverse, in a way that will positively affect dogs’ health and wellness. ”
Get Joy’ s entry into the metaverse is also a business opportunity. Having recently closed a $ 4 million seed round, the company is expanding its portfolio of products, its manufacturing capabilities and its nationwide distribution. Today Get Joy offers a line of balanced, nutritious products that support a dog’ s overall gut health, including fresh meals and fresh freeze-dried options.
“ Thinking about our future customer is always top-of-mind. The metaverse is full of future and current dog-owners. We want dog wellness to be front and center with that audience, and our hope is that the Get Joy Dog Zone will be a constant reminder to get your dogs outside or include them in what you are doing, ” says Arrix.
The future plan for the Get Joy Dog Zone is to build a bridge between real world and virtual interactions with the brand, deepen relationships with the company’ s customers, host events and non-profit activities that support dog wellness and also create commerce opportunities as the space matures. The Get Joy Dog Zone will serve as a beta test for the creation of the ultimate dog wellness experience Get Joy will be seeking to make a reality in real life communities.
Get Joy is food with purpose that focuses on wellness and prevention for your pet. Get Joy believes there is a direct correlation between the quality of our food and the quality of our lives. Nutrition has long been used to treat and prevent disease, just as diet and exercise are paramount to overall health and longevity of life for both people and pets. | tech |
Veriff launches HR identity verification solution to reduce friction in hiring and recruiting | Veriff has released enhanced identity verification solutions tailored specifically for the human resources and recruiting industries.
The suite of solutions streamline and automate the hiring and recruiting process to enable HR teams and staffing firms to cut costs and recruit faster while building trust and creating a smoother application process for candidates.
While the future of work might not be fully remote for everyone, the need to hire and retain the best talent wherever they are based in the world is a stark reality for most businesses. A growing reliance on digital tools due to the COVID-19 pandemic has led to an increase in identity fraud, leaving hiring teams to navigate everything from candidates sharing false information to the threat of human error within digital HR processes. Veriff’ s AI-powered identification platform and face match biometric authentication tool quickly ensures applicants are who they say they are while reducing human error and streamlining HR operations.
“ As fraud and online deception increases globally, organizations across industries will need to work even harder to build trust and confidence between their employees and customers – and HR management and staffing is no exception, ” said Janer Gorohhov, Veriff co-founder and CPO. “ Businesses need to take the necessary steps to ensure that applicants are truthful about their identity and work history while leaving no room for human error in their HR processes. With Veriff’ s latest identity verification tool, we are building trust within the hiring and recruiting process, helping HR teams and staffing firms cut costs and recruit faster to meet growing hiring demands. ”
Key benefits of Veriff’ s HR identity verification solution include:
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Virtualitics AI Platform to Support Computational Biology Research on Long Covid Treatment Options | Virtualitics Inc, an advanced analytics and predictive AI company announced that the Institute for Systems Biology ( ISB) will employ Virtualitics’ AI platform to enable researchers to discover the connections between vast amounts of Covid-related data for a research study on Long Covid treatment options. The research builds on a recent Long Covid study by ISB published in the journal Cell that uncovered four risk factors, measured before or at COVID-19 diagnosis, that identify which patients are likely to develop Long Covid.
“ Data analysis that has historically been conducted by our small team of data scientists will now be within reach for our entire team of researchers. This unlocks the potential for more scientific discovery at a pace that wasn’ t possible in the past, ” said Professor Jim Heath, President of the Institute for Systems Biology ( ISB) and senior author on the Cell paper.
ISB will use the Virtualitics AI Platform to give 150+ researchers direct access to advanced analytics tools that allow them to visualize and explore the connection between single-cell “ omics ” data and clinical data. Virtualitics’ patented visualizations makes advanced analytics accessible to non-data scientists and enables researchers to explore their research directly. By analyzing molecular and cellular interactions ( e.g. genomics, proteomics, etc.) with clinical patient data, researchers and analysts will be able to develop more accurate diagnosis methods and more precise treatment plans, ultimately leading to better patient outcomes.
“ Speed to insight is absolutely critical in this important Long Covid research. By partnering with Virtualitics, ISB is creating scalable decision intelligence and exponentially expanding the potential for scientific discovery. ” said Michael Amori, CEO and cofounder of Virtualitics.
“ The Virtualitics AI Platform accelerates product development for life sciences organizations, ” said Ciro Donalek, CSO and cofounder of Virtualitics. “ Our platform’ s embedded AI, 3D visualizations and the ability to easily share results bridges the gap between data scientists and researchers, enabling faster insights and better collaboration. ” | tech |
Ryanair targets billion-euro profit as demand defies higher oil prices | Ryanair CEO Michael O'Leary said: 'We’ d be disappointed if we don’ t do somewhere north of a billion in profits in the next 12 months. '
Ryanair is targeting at least €1bn in profit for the coming year as pent-up demand buoys summer sales and a strong hedging position helps protect against the higher price of jet fuel.
Europe’ s biggest discount airline expects to return to profitability and reach a goal of carrying 165m passengers in the 12 months from April 1, provided there’ s no major coronavirus flare-up and disruption from the war in Ukraine is contained, chief executive officer Michael O’ Leary said.
“ We’ d be disappointed if we don’ t do somewhere north of a billion in profits in the next 12 months, ” O’ Leary said in an interview on the fringes of an Airlines for Europe trade group meeting.
“ A lot of that is driven by advantageous fuel hedging. But it all depends on how strong the recovery is this summer. ”
Ryanair is 80% hedged at €56.7 a barrel on its jet-fuel requirements through next March, helping it to keep down prices even as competitors are forced to raise fares in response to the spiraling cost of crude.
The Dublin-based carrier will deploy 65 more planes this summer after taking deliveries from Boeing taking the total to 515, and plans to open up 250 new routes.
As you move into May, June, July, August, school holidays across Europe, we’ re seeing very strong demand patterns, both in volumes and pricing. | general |
Japan considering sending top envoy to Poland for talks on Ukraine refugees | Japan is making final arrangements to send Foreign Minister Yoshimasa Hayashi to Poland from Friday in place of Justice Minister Yoshihisa Furukawa, who was found to be a coronavirus close contact, government sources said Thursday.
The decision to send a representative to Poland is part of Tokyo's efforts to assist those fleeing Ukraine following the Russian invasion. Tokyo is considering transporting Ukrainians and Japanese nationals who have fled the war back to Japan on a government plane.
Furukawa was to leave for Poland on Friday as a special envoy of Prime Minister Fumio Kishida, but he was found to be a close contact of a family member infected with the coronavirus, according to the government.
Deputy Chief Cabinet Secretary Seiji Kihara said at a meeting of the House of Representatives steering committee earlier Thursday that the government was considering various options, including postponing the visit or sending Jun Tsushima, senior vice justice minister.
Justice Minister Yoshihisa Furukawa ( right) meets with Polish Ambassador to Japan Pawel Milewski at the Justice Ministry on Wednesday. | KYODO
Hayashi is now expected to make a five-day trip through Tuesday and meet with Polish Prime Minister Mateusz Morawiecki and high-ranking officials. Tsushima is set to accompany the foreign minister, the sources said.
Poland has received by far the largest influx of Ukraine refugees following Russia's invasion more than a month ago, and Kishida told Morawiecki last week in Belgium that Japan will accelerate its pace of accepting people who have fled the war.
Since March 2, when Kishida announced Japan would accept evacuees from Ukraine as part of its humanitarian response, more than 320 have been granted entry.
On Wednesday, the United Nations said more than 4 million refugees have now fled Ukraine since the start of the conflict, with over 2.3 million seeking refuge in Poland. | tech |
Explainer-What is the SPR, the emergency oil stash Biden is tapping? | The move is being undertaken because oil prices have spiked since Moscow's invasion of Ukraine on Feb. 24 and subsequent sanctions slapped on Russia by the United States and its allies.
The latest amount of U.S. oil release would make 180 million barrels of oil available, or the equivalent to about two days of global demand, and would mark the third time the United States has tapped the SPR in the past six months.
It is also possible that the International Energy Agency, the world's energy watchdog of which the United States is a member, may also release barrels when IEA countries meet on Friday.
The 31-member IEA, representing industrialized nations but not Russia, presided over the fourth coordinated oil release in its history on March 1 of over 60 million barrels of crude - its largest yet.
As part of the IEA's March release, the United States committed to release 30 million barrels of SPR oil.
Before that, Washington pledged in November to release 50 million barrels of SPR oil, though an expected move in tandem from China did not materialize, as prices surged along with demand recovery for the COVID-19 pandemic.
WHY WAS THE SPR CREATED?
The United States created the SPR in 1975 after the Arab oilembargo spiked gasoline prices and damaged the U.S. economy.Presidents have tapped the stockpile to calm oil markets duringwar or when hurricanes hit oil infrastructure along the U.S.Gulf of Mexico.
HOW MUCH OIL DOES THE SPR HOLD?
The reserve currently holds about 586 million barrels indozens of caverns in four heavily guarded locations on theLouisiana and Texas coasts. The country also maintains small heating oil and gasoline reserves in the U.S. Northeast.
HOW DOES THE SPR GET OIL TO MARKET?
Because of its location near big U.S. refining orpetrochemical centers, the SPR can ship as much as 4.4 million barrels per day. It can take only 13 days from a presidential decision for the first oil to enter the U.S. market, according to the Energy Department.
Under a sale, the Energy Department usually holds an online auction in which energy companies bid on the oil. Under a swap, oil companies take crude but are required to return it, plusinterest.
Prior to the last six months, U.S. presidents have authorized emergency sales from the SPR three times, most recently in 2011 during a war in OPEC member Libya. Sales also took place during the Gulf War in 1991 and after Hurricane Katrina in 2005.
Oil swaps have taken place more frequently, with the lastexchange held in September after Hurricane Ida.
WHAT OTHER COUNTRIES HAVE STRATEGIC RESERVES?
The United States is responsible for about half of the world's strategic petroleum reserves.
The United States and the other IEA member countries that include Britain, Germany, Japan and Australia are required to hold oil in emergency reserves equivalent to 90 days of net oil imports. Japan has one of the largest reserves after China and the United States.
China, an associate member of the IEA and the world'ssecond-leading oil consumer, created its SPR 15 years ago andheld its first oil reserve auction in September. Another IEA associate member, India, the third-biggest oil importer and consumer, also maintains a reserve.
State storage across the Organisation for Economic Cooperation and Development, most of whose members belong to IEA, came to nearly 1.2 billion barrels of crude as of January, according to the IEA.
( Reporting By Tim Gardner in Washington; Editing by David Gaffen and Marguerita Choy)
By Timothy Gardner | business |
Lost Women of Science Podcast, Season 2, Episode One: The Grasshopper | The first modern-style code ever executed on a computer was written in the 1940s by a woman named Klára Dán von Neumann—or Klari to her family and friends. And the historic program she wrote was used to develop thermonuclear weapons. In this season, we peer into a fascinating moment in the postwar U.S. through the prism of Dán von Neumann’ s work. We explore the evolution of early computers, the vital role women played in early programming, and the inextricable connection between computing and war.
To understand how Dán von Neumann arrived at computer programming, we need to first understand where she came from. Born in Budapest to a wealthy Jewish family, she grew up surrounded by artists, playwrights and intellectuals. Her first marriage to an inveterate gambler took her on a tour of Europe’ s casinos. And in one of them, she had a chance encounter with the famous mathematician John von Neumann.
This podcast is distributed by PRX and published in partnership with Scientific American.
PRESIDENT HARRY S. TRUMAN: The world will note that the first atomic bomb was dropped on Hiroshima….
KATIE HAFNER: World War II started an international arms race.
KATIE HAFNER: New machines made weapons as precise and deadly as possible.
ARCHIVAL TAPE: It’ s the world’ s first electronic computer.
KATIE HAFNER: But those machines couldn’ t function without instructions.
ARCHIVAL TAPE: The only requirement now is that we tell our computer what to do. This is the job of an individual called a programmer.
KATIE HAFNER: Klara Dan Von Neumann –Klari to her family and friends–helped bring one of those machines – one of those famous and infamous objects – to life. And in doing so, she became one of the world’ s first computer programmers.
I’ m Katie Hafner, and this is Lost Women of Science, where we unearth stories of scientists who didn’ t receive the recognition they deserved in their lifetimes.
Our second season is all about Klara Dan von Neumann and her place in computer history.
JANET ABBATE: I’ m Janet Abbate, and I’ m a professor at Virginia Tech in the department of Science, Technology and Society.
KATIE HAFNER: In 1999, Janet wrote a book called Inventing the Internet.
JANET ABBATE: And while I was working on that, I kept looking for the women in the story.
KATIE HAFNER: But she didn’ t find many.
JANET ABBATE: And I thought, well, my next book, I 'm going to go find the women in computing. And I thought there weren’ t going to be that many because nobody had written about them.
KATIE HAFNER: And so, she went back to the 1940's, the dawn of electronic computers.
JANET ABBATE: They were just so invisible I thought, well, there couldn't have been that many and I couldn't have been more wrong.
KATIE HAFNER: The gender landscape of the 1940’ s computer scene, it turns out, was not completely male-dominated. In fact, it was actually common for women to be coders then.
And that’ s one of the things Janet wrote about in her next book: Recoding Gender.
But one name was noticeably absent: Klara von Neumann.
JANET ABBATE: to be completely honest. I, I know virtually nothing about her.
KATIE HAFNER: I’ ve also been writing about computers for a really long time, more than 30 years in fact —I’ ve read countless histories, and I even co-wrote one in 1996. But last year, as we were putting together our Lost Women of Science list of the overlooked and under-credited, the name Klara von Neumann caught me off guard.
She was married to John Von Neumann, the famous Hungarian mathematician and computer pioneer–I certainly knew who that was. She worked on Monte Carlo simulations, which were first used for atomic bomb calculations but have since become a fixture of the computing landscape. Today, the Monte Carlo method is used to make sense of huge volumes of data–and do things like predict elections and model the spread of COVID-19 –I knew about Monte Carlo simulations too. Klari also wrote code for the ENIAC, an early electronic computer. Anyone who has spent a good amount of time writing about computers has heard of the ENIAC. But in the middle of all these knowns, was this new name. This new character.
JANET ABBATE: Or maybe I shouldn't be surprised that I hadn't really heard about Klara Von Neumann. Um, I guess that's the point of having this season.
KATIE HAFNER: Indeed, it is the entire point of this season. And so I started digging.
... And, it turns out, Klari’ s life was hiding just out of plain sight. At the Library Congress, we stumbled upon a trove of documents that were saved alongside her husband’ s –letters, legal forms, manuscripts, computer code, pay stubs, diaries. Our problem became sorting through the material, constructing a life out of thousands of pages...
SOPHIE MCNULTY: I think this is a mix of Hungarian and English.
KATIE HAFNER: I’ m a little worried about all the Hungarian. We should just scan everything.
She was from a wealthy Jewish family in Budapest. She married John von Neumann, a famous genius, and she was brought into this coding work kind of randomly.
But who was this person, really? What can she tell us about the origins of computing? And how did she get so lost? In this season, we’ re going to get to the bottom of those questions, and then some.
For this episode, our first of the season, our goals are twofold: To paint a picture of Klari’ s early years, bringing this unusual, colorful character to life. And to lay out the story of how she ended up in the United States –her entry point into a world of secrecy and computers and nuclear weapons.
In order to understand this story ourselves, we needed to get our hands on a particular document–a manuscript that would ground us as we mapped out her life. It’ s a manuscript that we knew existed because the Library of Congress had fragments of it, but we caught wind that the rest of it was somewhere else…
MARINA VON NEUMANN WHITMAN: Hi Katie.
MARINA VON NEUMANN WHITMAN: Come on in. Oh my goodness.
KATIE HAFNER: It’ s the very last.
MARINA VON NEUMANN WHITMAN: Thank you, yes, how great, thank you.
KATIE HAFNER: The last dahlias, the last statice.
MARINA VON NEUMANN WHITMAN: Well, just that one.
KATIE HAFNER: I just picked them this morning.
I’ ve just arrived in Concord, Massachusetts at the home of Marina von Neumann Whitman, a prominent economist who’ s now retired. She’ s Klari’ s step daughter.
Klari died almost 60 years ago, but Marina is still holding onto some of her stepmother’ s old papers. Our first stop: Marina’ s study.
MARINA VON NEUMANN WHITMAN: Yeah.
KATIE HAFNER: I’ m pointing at four files I see on a high shelf.
MARINA VON NEUMANN WHITMAN: No, wait a minute. I think I can do it.
KATIE HAFNER: Yeah, you're tall. You're tall. …
MARINA VON NEUMANN WHITMAN: Oh yeah. Well, I was taller.
MARINA VON NEUMANN WHITMAN: Uh, let’ s see.
MARINA VON NEUMANN WHITMAN: There’ s one more.
KATIE HAFNER: …then leads the way to her dining room table.
KATIE HAFNER: The document I’ m looking for is Klari’ s unpublished memoir. And as promised…here it is.
KATIE HAFNER: So it's four folders, um, with little ties on them. And I am opening this one folder that says “ miscellaneous typescripts ”, and then “ drafts of following: Two New Worlds, Not So Merry Washington, the Blue Humber, the Computer and the Grasshopper. ”
KATIE HAFNER: According to the table of contents, the memoir was to be divided into 8 chapters and a postscript. Marina has either full or partial drafts of 6 of them. They’ re all typewritten in English, a few of them over and over again as Klari produced new drafts, editing by hand in the margins in her familiar, illegible – scrawl.
MARINA VON NEUMANN WHITMAN: The proposed title was very revealing. It was called “ A Grasshopper in Very Tall Grass. ” So she obviously saw herself as this little creature sort of buried in a much taller environment. I don't think she ever realized how remarkably intelligent she was.
KATIE HAFNER: And if Klari was this grasshopper, her tall grass could have been a lot of things…From the towering mind of John von Neumann, her husband, to the skyscrapers in the US, where she was an immigrant. From the overwhelming personal tragedies she would one day experience, to the entire universe she would find herself in…surrounded by famous scientists who were building weapons that were unlike anything the world had seen.
Klari was already in her mid-thirties when she joined these scientists and started to code. By then, she’ d already lived many lives. Her path to programming was serpentine and unusual. She herself, complicated and layered.
We know the result of her work, because we’ re living in it. The question is, where is she in all of this? And a fundamental part of that question is: Who was Klara Dan von Neumann?
So before we get into stored-program computers and flowcharts and simulation algorithms, we need to take a step back, and meet Klari the person…this self-described “ grasshopper in very tall grass. ”
KATIE HAFNER: That’ s one of our translators, Eva Szabo, reading from the manuscript I found at Marina’ s.
KLARA VON NEUMANN: …the capital of that lighthearted, gay country best known for its gypsy music and songs…and for its hopelessly unhappy and unlucky history.
KATIE HAFNER: The Budapest of Klari Dan’ s childhood was in constant flux. By the time Klari was 10, she had lived through a World War and a violent communist revolution in Hungary.
GEORGE DYSON: She came from, from a very wealthy aristocratic family.
KATIE HAFNER: That’ s George Dyson, a historian of technology. He wrote Turing’ s Cathedral, a book about the origins of the digital universe.
GEORGE DYSON: She had been a very pampered child. A figure skating, national figure skating champion at age 14.
KATIE HAFNER: In an early passport photo we found, she had short, curly brown hair, and big, piercing gray-brown eyes. In non-official photos, she wears glasses and she’ s often smiling.
MARINA VON NEUMANN WHITMAN: And I 'm told she was a great beauty.
KATIE HAFNER: That’ s Marina again. George also visited Marina to read Klari’ s papers. In fact, he beat me by 10 years. He was looking for any material he could find on early computers.
GEORGE DYSON: this was the first person record of all this questionable stuff, you know, what happened during the Oppenheimer hearings? What happened during the Monte Carlo. It’ s all there in, you know, fountain pen. And here's Klari who just is there, and she's doing things, and it was just clear cut.
KATIE HAFNER: But long before Klari found herself immersed in the world of Monte Carlo simulations and people like J. Robert Oppenheimer and Albert Einstein, back when she was a young girl, her life seemed to be going in, well, not that direction.
GEORGE DYSON: She was well educated, but certainly didn't show any interest in science or anything like that.
KATIE HAFNER: Klari was not a budding scientist, but she was getting a very idiosyncratic education, surrounded by Europe’ s best and brightest.
GEORGE DYSON: Just sort of this insanely interesting intellectual group of people, you know, you’ d turn around at breakfast and there would be a playwright or an artist or a great mathematician.
KATIE HAFNER: Her extended family was large and tight-knit, and they all lived together in separate flats of an extravagant villa, which still stands to this day at the top of the Gellért hill, one of the most beautiful neighborhoods in all Budapest. And the house…
KLARA VON NEUMANN: …gradually became the center of the “ Roaring Twenties ” Budapest version.
KATIE HAFNER: At Klari’ s family home in Budapest, there was a constant flow of celebrated figures in and out. They would host huge parties that lasted all night.
GEORGE DYSON: It was sort of a mix between a scientific conference and a rave or something.
KLARA VON NEUMANN: It is absolutely impossible to translate “ mulatsag ” in one simple word. It is not a party, it is not a feast, it is not even an orgy; it is simply the spontaneous combustion of a bunch of people having a good time.
KATIE HAFNER: And Klari loved meeting these colorful characters.
KLARA VON NEUMANN: I, a tiny little speck, an insignificant insect just chirping around to see where the most fun could be had.
KATIE HAFNER: Klari defines herself as this little speck, this grasshopper looking for fun. And, my first instinct is to fight this. Because, her letters show a complicated, deep, emotional person–not just a hedonist. And definitely not a speck.
AGI ANTAL: She had huge heart. I mean, she was so very open-hearted, so, so nice to everybody who she loved.
KATIE HAFNER: That’ s Agi Antal, another Hungarian translator. She’ s describing the sense she got of Klari after reading a bunch of her letters.
AGI ANTAL: It is a pity that she had not more self confidence. She should have had. You know how it is, the most brilliant people don't believe how brilliant they are.
KATIE HAFNER: Klari was self-deprecating to a fault. Other people seemed bigger and more important. Relationships drove her life. For instance, this is how she frames her memoir:
KLARA VON NEUMANN: This is a sort of autobiography about other people.
KATIE HAFNER: Among these other people were the men she loved and married. Her marriages gave her access to other ways of living, of being. Through her marriages, she got many things – opportunity, purpose, travel. Marriage, for Klari, wasn't just an objective, but also a vehicle–a useful one in a man’ s world.
The beginnings of this lifelong search for love and fulfillment are documented in her private diary. We found it buried in a file in a box at the Library of Congress.
The diary is rich blue and stamped with gold flowers. It’ s the type of thing you want to admire before opening. Inside, is Klari’ s teenage heart —
KLARA VON NEUMANN: Three long years of struggle and pain come to an end with this page. I’ ve been living in this intoxication of love for almost three weeks.
And this first love, Francis, won her over with his adventurous and impulsive nature. They got married in May of 1931, when Klari was only 19, and the relationship took Klari on something like a tour of Europe’ s casinos.
KLARA VON NEUMANN: I was most frightfully in love, the grandiose flinging of the last chip on the table seemed to me the most manly and elegant gesture…until one day it dawned on me that those colored chips were just about all the money we had.
KATIE HAFNER: Even Klari, a fan of spontaneity and whimsy, was growing increasingly frustrated by her marriage.
And this was how she was feeling one fateful night, when she arrived in Monte Carlo, Monaco’ s famous gambling hotspot.
KATIE HAFNER: That’ s Ananyo Bhattacharya, who’ s just published a biography on John Von Neumann called The Man from the Future.
ANANYO BHATTACHARYA: and whilst he's busy gambling away their money, she gets bored and she retires to the bar. But, just before she leaves the roulette wheel, she bumps into John von Neumann, a fellow Hungarian. And he's, uh, a minor celebrity. A Hungarian would, uh, would know of him.
KATIE HAFNER: This was the early 30s. But, Ananyo says John von Neumann eventually became almost as well known as Albert Einstein. Some considered him even smarter. As a child, he memorized entire chapters of books. And it’ s said that by eight, he had mastered calculus.
PAUL HALMOS: Essentially it was his genius at synthesizing and analyzing things.
NARRATOR: Proved the mean ergodic theorem….
PAUL HALMOS: That's what Johnny could do and what no one else could do as well.
NARRATOR: Provided a mathematical foundation for quantum theory...
OSCAR MORGENSTERN: He would think all the time.
OSCAR MORGENSTERN: He worked with tremendous energy and fantastic speed.
NARRATOR: And done basic work in foundations of mathematics.
ANANYO BHATTACHARYA: von Neumann was considered almost a species apart.
KATIE HAFNER: And that night in Monte Carlo, Klari found this powerful, almost mythical brain sitting at the bar. She would later recall that Johnny was quote “ babyishly plump and round like a child’ s drawing of the man on the moon. ” He was wearing his characteristic three-piece suit–he would never be caught dead in anything else, even on hikes or horseback.
ANANYO BHATTACHARYA: They, they start chatting and, uh, he explains he has a system, to win, uh, roulette.
KATIE HAFNER: Of course he does. Right?
ANANYO BHATTACHARYA: yeah, it's fail safe, fail safe, he says. So he loses all his money.
KATIE HAFNER: That's some system.
ANANYO BHATTACHARYA: Um, yeah, it turned out it wasn't foolproof. So he then, uh, finds her at the bar and uh, basically says, will you buy me a drink? And she agrees.
KATIE HAFNER: But, this was the early 1930’ s, and Klari was married and so was Johnny. So Johnny went back to his wife in the US, and Klari stayed in Europe with her husband, and life went on for a while.
But this meeting in Monte Carlo was important.
For one thing, these two people liked each other, and they wouldn’ t forget it.
And for another: Monte Carlo would reappear in a place they couldn’ t have expected. In the late 1940s, Klari and Johnny would work on a computer program to execute a mathematical algorithm, and that algorithm would be named for that very gambling hotspot: It’ s called the Monte Carlo method.
KATIE HAFNER: That’ s Nic Lewis, a historian of technology at Los Alamos National Laboratory.
NIC LEWIS: in order to make predictions about parts of the natural world. Say the motion of particles without having to do detailed calculations on the possible behavior of every single particle.
KATIE HAFNER: So the Monte Carlo method imagines many possible outcomes of a particular event—like the motion of particles. And then it simulates the event over and over again, to determine the probability of each outcome. It uses randomness to solve problems.
GEORGE DYSON: And it's sort of a window into the way that that physics is really, is really working.
KATIE HAFNER: For example: say you’ re sitting at that roulette wheel in Monte Carlo, placing your bet. The ball will land in one of 37 slots. But what would it take to derive an equation accounting for every variable? The ball’ s initial position, its kinetic energy, its angular momentum – and all the other factors: the friction acting on the ball, the ricketiness of the table, the crookedness of the house.
It’ s reasonably simple to state mathematically how each individual factor shapes the odds for what the ball will do in the next small fraction of a second: spin smoothly, deflect from an obstacle, or settle in a landing slot. But deriving a single equation to predict the odds for final landing positions directly from starting conditions is much, much harder. So instead, Monte Carlo uses statistics. It plays endless rounds at a simulated wheel, collects the data, and presents its findings.
Meaning, with the Monte Carlo Method, you’ re living out the possible scenarios of what could happen to get a sense of what’ s probable.
But, in simulating all of these scenarios, in walking down all these paths, the unlikely is eventually, inevitably realized.
And this ability to map out not only what is probable, but also what is improbable, might be a fitting analogy for Klari’ s own life.
She went down many random paths….
KLARA VON NEUMANN: It was sheer luck, and a strong tendency for rainbow-chasing, that made me a wanderer on two continents among this maze of people.
KATIE HAFNER: …until she kind of just fell into the world of computing by way of a marriage.
THOMAS HAIGH: Klara Von Neumann, as far as we know, did not have an interest in mathematics or science or nuclear weapons.
GEORGE DYSON: Yeah, she really was just, you know, in the right place at the right time.
KATIE HAFNER: And so although a life full of bomb calculations, coding, and famous physicists was not the most probable one for a young figure-skating champion from Hungary, it had a non-zero probability, and she–this grasshopper always looking for better horizons–sampled different outcomes, until she landed there.
NIC LEWIS: Her life was improbable, but not impossible.
KATIE HAFNER: Coming up, we’ ll look at what happened after two Hungarians walked into a casino, and met at the bar. I’ m Katie Hafner and this is Lost Women of Science.
KATIE HAFNER: Klari’ s chance meeting with Johnny at Monte Carlo had ripple effects that spanned an ocean. Their relationship changed the course of her life and maybe the course of early computer programming too. Soon Klari would face the second world war to occur in her lifetime. And in the aftermath take part in making deadlier warfare possible. But, in the early 1930s, this reality was still very far off. Klari was married to someone else. And so was Johnny.
And besides, he lived halfway across the world in Princeton, New Jersey. He worked first at the University there as a visiting professor, then later as mathematics professor at the Institute for Advanced Study.
And that’ s where he went after that brief encounter at the casino, returning to his work and his wife, Mariette. Their daughter, Marina ( yes, the same Marina from earlier) says her mother was a “ shining star. ”
MARINA VON NEUMANN WHITMAN: She liked being the center of attention and I think it annoyed her that she was so much in the background.
KATIE HAFNER: And Johnny, as Ananyo points out, wasn’ t always the doting husband.
ANANYO BHATTACHARYA: He was never very plugged into, any kind of, uh, domesticity. He was pretty clueless.
ANANYO BHATTACHARYA: She rapidly gets tired of being a rather distant second in von Neumann's list of priorities, which, you know, he's described by his friends as being addicted to thinking. And so, um, Mariette, uh, leaves him for, um, another physicist actually. Um, and, uh, he never really understands why.
KATIE HAFNER: Johnny was heartbroken. And confused. Why would she trade a perfectly fine genius-husband, for a non-genius husband?
And so, in 1937, in the midst of his heartache, Johnny went back to Budapest for a visit.
ANANYO BHATTACHARYA: And he basically looks up Klara Dan. Unfortunately, Klara has remarried, uh, this time to a banker who's 18 years older than she was.
KATIE HAFNER: While Johnny had been in Princeton, Klari had kept herself busy in Budapest. After that fateful night in Monte Carlo, Francis, Klari’ s first husband, kept gambling away their money. In one extreme episode, Klari and Francis took a road trip across the south of Europe. Francis lost all of their cash ( and then some!), stranding them in northern Italy, without enough gas money to get home. When Francis continued gambling after that, they finally got divorced in 1936. And then, a month later, Klari promptly replaced him with his opposite: a respectable banker 18 years her senior. In her memoir, she calls him her “ daddy husband. ”
KLARA VON NEUMANN: He was a kind, gentle, attentive husband... and I was bored to tears.
KATIE HAFNER: So while yes, she was married, Johnny’ s return to Budapest in the summer of 1937 could not have come at a better time.
ANANYO BHATTACHARYA: They start talking first on the telephone and then they started meeting in cafes and they talked for hours. She said the subject of conversation veered wildly from politics to ancient history. And the differences between America and Europe. And the advantages of having a small Pekinese or a Great Dane.
KLARA VON NEUMANN: It became perfectly clear that we were just made for each other.
GEORGE DYSON: You know, they were immediately obsessed with each other. And again, she was just so magnetic and charming and, and carefree in a way. And he was the smartest guy she’ d ever met.
KATIE HAFNER: But like summer camp, it had to end. Johnny went back to the U.S. and Klari stayed in Budapest, but there was no stopping things…
ANANYO BHATTACHARYA: And their exchanges continue through letters and telegrams.
KATIE HAFNER: Hundreds of these letters and telegrams are now preserved at the Library of Congress.
Klari’ s own files are largely subsumed by her husband’ s, and four of us spent the better part of a week there, looking for anything we could find in Klari’ s tall sloping hand.
At first glance, her elegant old Hungarian script looks like a seismic readout, the words themselves are bunched up on the page and they slant to the right, as if headed somewhere. We had trouble telling which of her many languages these were written in. Her native Hungarian? English? Or were we seeing some rare use of her German or French? She knew them all.
Johnny’ s letters also seamlessly moved from language to language – but unlike Klari’ s, his have been sorted, pored over, and luckily for us, transcribed and translated. And so, a lot of what we pieced together of their relationship came from Johnny rather than Klari.
And Johnny started writing to Klari immediately after that romantic interlude in 1937. Here’ s Nandor Tary reading from one of Johnny’ s letters:
JOHN VON NEUMANN: A billion thanks for the letter. It is lovelier than anything I could imagine, warmer than anything I ever hoped, it’ s all together the sweetest thing – it’ s almost like yourself.
KATIE HAFNER: These early love letters are unbelievably sweet. Still, it quickly became clear that the woman Johnny had decided to hitch his heart to was a complicated person.
There’ s one letter in particular, which I call The Long Dark Letter. It’ s about ten pages. Johnny wrote it on a stopover in Milan in August of 1938…This Long Dark Letter is a stunning document, really, because it demonstrates with remarkable prescience the rocky emotional road ahead for these two people. The letter shows that Johnny cared about Klari deeply.
JOHN VON NEUMANN: is this evil world bothering you all night? The world that does not give you what you should have deserved long ago, Happiness.
My heart breaks to think of you being worried, and restless in a long dark night.
KATIE HAFNER: Their impassioned letters are a blizzard of emotional outpouring. They suggest a couple who were constantly reaffirming their connection. These are two people who weren’ t simply infatuated – they were well matched – Johnny, the fiery but jovial scientist with a mind in perpetual motion, and the equally fiery quick-witted, fun-loving Klari.
KLARA VON NEUMANN: The inevitable of course happened.
ANANYO BHATTACHARYA: And she tells her husband that basically the, the, the, their marriage is over. And, um, he seems to take it pretty well.
KATIE HAFNER: In 1938, a few months after Klari’ s 27th birthday, Klari and Johnny got married.
ANANYO BHATTACHARYA: Klari’ s divorce comes through at the end of October, they get married within two weeks and they sail back to America the next month in November.
KATIE HAFNER: Klari seemed like the sort of person well-suited to such a move. She was a well-seasoned traveler, good at adjusting to new people and places. But, when the couple finally got to Princeton, it wasn’ t quite the newly wed life that Klari had imagined–even jaded as she was by her prior marriages. For one thing, Johnny was immediately hard at work at the Institute for Advanced Study leaving Klari to her own devices in this totally foreign place.
ANANYO BHATTACHARYA: All this time, of course a war is creeping closer.
JOHN VON NEUMANN: All these treaties of different military powers are leading to war, I believe more than ever.
KATIE HAFNER: Germany had already annexed Austria and Hitler was poised to invade Poland. And Johnny and Klari’ s Jewish families were still in Budapest.
ANANYO BHATTACHARYA: She actually returns to Europe… Klari goes back to try and convince her parents and, uh, von Neumann’ s mother and brother, uh, to leave. Klari manages this but she stays to conclude family business and wrap things up.
KATIE HAFNER: Johnny’ s letters suggest that Klari’ s father dragged his feet in leaving Budapest, and that he wanted Klari to see to some important matters—perhaps liquidating some assets, or selling off property. All of which kept Klari in Europe for too long…
ANANYO BHATTACHARYA: Johnny is, uh, writing to her desperately.
JOHN VON NEUMANN: Darling, For God’ s sake do not go to Pest, and get out of Europe by the beginning of September! I mean it! Don’ t be a fool. Come back!
GEORGE DYSON: He knew how bad things were in Europe and how it really was a matter of life and death to get out of there.
KATIE HAFNER: Klari knew it was dangerous, too. Like many other Jews in Europe, she and her family had converted to Catholicism–as did Johnny–to stay safe in the face of rising anti-Semitism.
ANANYO BHATTACHARYA: She was really quite extraordinary…She had the most remarkable presence of mind.
KATIE HAFNER: Klari set sail on August 30th, 1939. Then, just as Johnny predicted, on September 1st…
ARCHIVAL TAPE: These are today’ s main events, Germany has invaded Poland.
ANANYO BHATTACHARYA: She also clearly was quite lucky because she jumped on that boat just in time.
KATIE HAFNER: So as war broke out in Europe, Klari was sailing towards her new life in the United States.
It might not be surprising to hear that someone on marriage number three by age 27, was prone to discontent. And, when faced with discontent, Klari took action.
She was constantly gambling, taking chances on unusual characters and dipping into new, strange worlds. But her letters and memoir don’ t reveal a thoughtless or frivolous person. Just like the Monte Carlo experimenter, Klari was harnessing randomness towards her own ends. She was striving for something, willing to completely upend her current life for the hope of something more and better…
Next time on Lost Women of Science…where that got her.
This has been Lost Women of Science. Thanks to everyone who made this initiative happen, including my co-executive producer Amy Scharf, producer Sophie McNulty, associate producer Ashraya Gupta, senior editor Nora Mathison, composer Elizabeth Younan, and the engineers at Studio D Podcast Production.
Thanks also to our voice actors Eva Szabo and Nandor Tary, as well as our many Hungarian translators: Agi Antal, Rick Esbenshade, Charles Hebbert, Laszlo Marcus, Alina Bessenyey Williams, and Lehel Tary.
We’ re grateful to Mike Fung, Cathie Bennett Warner, Dominique Guilford, Jeff DelViscio, Meredith White, Bob Wachter, Maria Klawe, Susan Kare, Jeannie Stivers, Linda Grais, Rabbi Michael Paley, Marina von Neumann Whitman, George Dyson, Thomas Haigh, and our interns, Hilda Gitchell, Kylie Tangonan, Leeza Kopaeva, and Giuliana Russo. Thanks also to the Computer History Museum, to Paula Goodwin, Nicole Searing and the rest of the legal team at Perkins Coie, and to the Institute for Advanced Study, the Library of Congress, and the UCSD Special Collections for helping us with our search. Many thanks to Barnard College, a leader in empowering young women to pursue their passion in STEM for support during the Barnard Year of Science.
A special shout out to the Women’ s Audio Mission in San Francisco, where this podcast was recorded.
Lost Women of Science is funded in part by the Gordon and Betty Moore Foundation, Schmidt Futures and the John Templeton Foundation, which catalyzes conversations about living purposeful and meaningful lives.
This podcast is distributed by PRX and published in partnership with Scientific American.
You can learn more about our initiative at lost women of science dot org or follow us on Twitter and Instagram. Find us @ lostwomenofsci.
Thank you so much for listening. I’ m Katie Hafner.
[ The above text is a transcript of this podcast. ] | science |
BYOD and enterprise mobility market to reach $ 157.3 billion by 2026 | Amid the COVID-19 crisis, the global market for BYOD and enterprise mobility estimated at $ 84.4 billion in the year 2022, is projected to reach a revised size of $ 157.3 billion by 2026, growing at a CAGR of 16.7% over the analysis period, according to Global Industry Analysts.
Devices, one of the segments analyzed in the report, is projected to record a 15.4% CAGR and reach $ 82.4 billion by the end of the analysis period. After a thorough analysis of the business implications of the pandemic and its induced economic crisis, growth in the Software segment is readjusted to a revised 16.9% CAGR for the next 7-year period.
With COVID-19 ushering in a phase of social distancing and lockdowns, the trend towards remote working has gained momentum, stronger than ever before. There is a growing need for tools that allow teams to collaborate virtually. Due to this shift in work culture, access to corporate resources from home has surged, leading to quantum rise in network traffic.
Staying ahead of the competition involves embracing needed change which in the current times is companies going digital, enabling remote working options and adopting the Bring your own device ( BYOD) approach, that are all characteristics of enterprise mobility. Enterprise mobility adds agility to the system and in turn enables businesses stay operational during times of crisis.
The BYOD and enterprise mobility market in the U.S. is estimated at $ 26.1 billion in the year 2022. China, the world ` s second largest economy, is forecast to reach a projected market size of $ 33.7 billion by the year 2026 trailing a CAGR of 20.8% over the analysis period.
Among the other noteworthy geographic markets are Japan and Canada, each forecast to grow at 14.2% and 15.6% respectively over the analysis period. Within Europe, Germany is forecast to grow at approximately 14.2% CAGR. In the US, Japan, and Europe, adoption of mobility solutions is widely popular across several end-use markets, including banking, finance & insurance ( BFSI) entities, B2C companies, healthcare providers, retail chains, logistics & distribution companies, and manufacturing units, which makes enterprise mobility an established and well accepted enterprise communications technology.
Characterized by strong mobile application deployments, growing number of mobile workforce, and relatively lower penetration of enterprise mobility solutions, Asia-Pacific represents a strong market for mobile enterprise infrastructure software and services. Cloud deployment and increasing use of mobile devices for business purposes is fueling the growth in the Asia-Pacific region.
Given its widely accepted role in improving the overall responsiveness, agility, and flexibility of an organization, enterprise mobility has truly transformed into a competitive requirement in today’ s worldwide marketplace. Enterprise mobility refers to working or conducting business anytime, from anywhere using personal laptops and mobile devices, facilitated by the adoption of cloud technology for data access.
The paradigm shift from the traditional office model to the digital workplace is attributed to the growing need for adaptability. The growing popularity of BYOD trend, propelled by increasing preference to working remotely, is a driving factor behind the market growth. The numerous benefits of workplace mobility such as enhanced employee satisfaction, improved communications between organizations within a company, schedule flexibilities and increased productivity are factors driving companies to adopt enterprise mobility.
Traditional solutions are being substituted by EMM vendors who can provide consolidated services for a variety of mobile appliances along with hybrid IT deployment. The future will see a shift to Internet of things ( IoT) products and services. EMM and ( IoT) together can improve user productivity by enhancing collaboration and decision making. EMM is emerging as a one stop solution for encryption, user authentication, anti-virus controls and remote data/device access.
Cloud computing makes the enterprise mobility solution more accessible and flexible. The need for cloud-based software grew significantly in the pandemic period, with more number of organizations embracing enterprise mobility and motivating the employees to be productive while working remotely.
As the number of mobile workforce increases and as organizations provide a flexible work environment for employees, companies are shifting to cloud-based applications in order to manage different functions and various mobile devices from a single controlled environment.
In the global cloud ( deployment) segment, USA, Canada, Japan, China and Europe will drive the 18% CAGR estimated for this segment. These regional markets accounting for a combined market size of $ 34.3 billion will reach a projected size of $ 112 billion by the close of the analysis period.
China will remain among the fastest growing in this cluster of regional markets. Led by countries such as Australia, India, and South Korea, the market in Asia-Pacific is forecast to reach $ 14.1 billion by the year 2026
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Ukraine: Emergency Protection Coordinator Consultant | FHI 360 is harnessing its four decades of development experience to provide humanitarian assistance in crisis-affected countries. FHI 360’ s Crisis Response Team ( CRT) meets the urgent needs of people whose lives are jeopardized by conflict, disaster or displacement. FHI 360’ s Crisis Response Team is looking to expand operations and technical programming in Chernivtsi, Ukraine to respond to the current crisis. FHI 360 is responding to the conflict by intervening in the health, nutrition, protection, and WASH sectors.
In this particular context, the Crisis Response Team requires the services of a highly skilled Protection Consultant to support HQ staff by implementing a protection program during the initial start-up phase in Chernivtsi, Ukraine. The Emergency Protection Consultant will engage with cluster leads, government of Ukraine officials, health facility-based personnel and other NGO partners to discuss the pressing needs and challenges of the impacted area. The consultant will conduct start-up activities with respect to sector specific best practices, barriers to access, and potential for innovative interventions to produce a fully integrated protection program. The consultant must also have a strong background in humanitarian programming and experience with rapid startups.
Important Note: Applicant should research COVID-19 measures and the associated risks of this location before submitting an application.
Applications must be prepared in English and delivered electronically by 15 April 2022, 11:59PM EDT. Please send by email to CrisisResponse @ fhi360.org with subject line “ RFP - Emergency Protection Consultant – Ukraine ”.
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Joblist Launches Job Postings To Help Employers Hire | Joblist, a job search platform that personalizes the process of finding and landing a job, officially launched a job posting product aimed at helping employers find and recruit more quality candidates. The affordable, self-serve solution allows companies to promote their job openings to Joblist’ s large audience of job seekers in just a few quick steps, with no account, unexpected charges, or long-term commitments required.
Joblist’ s new job posting product comes at a critical time, as many businesses struggle to hire workers. According to the CBNC/SurveyMonkey Q1 2022 Small Business Index, 52% of small business owners say it’ s become more difficult to find qualified candidates in the last year and 29% report being unable to fill positions that have been open for three or more months. As a result, 40% of small businesses in March 2022 cite identifying and hiring new employees as the top need facing their business.
“ The COVID-19 pandemic and Great Resignation have created hiring challenges for all employers, but especially SMBs, ” said Kevin Harrington, CEO of Joblist. “ It takes too long and costs too much to find the right candidates. We need more effective avenues for employers of all sizes to fill open roles. That’ s where Joblist can help address an unmet need. ”
Joblist’ s solution allows anyone in a hiring position – from a recruiter at a large company to a local business owner – to post a job in just a few clicks. Once an opening is posted, Joblist uses its personalized matching technology to advertise the position to active candidates via the Joblist website, as well as through the company’ s partner channels.
To make the experience as seamless as possible, no account is required to post an opening on Joblist. Candidate applications are delivered to the employer using their choice of the most convenient channel for them, either directly through email or their own career page.
Postings on Joblist start at a flat rate of $ 150 for 30 days with no auto-renewals or hidden fees, making the service one of the most affordable and transparent on the market. The product is currently available to U.S. employers only.
Prior to today’ s announcement, Joblist has been testing its job posting service with customers and built significant traction. Over 1,800 employers from across the country already post on Joblist, including at least one employer from every single state and more than 1,000 distinct cities and towns.
Joblist has helped over 50 million people with their job search since its debut and now aims to bring the same scale and impact to its employer customers. Looking ahead, the team is focused on building even more tools and services to help employers and candidates find the right matches as quickly and easily as possible. | tech |
Russians are fewer, poorer and more miserable than a decade ago | When he returned to the presidency in 2012 after a four-year hiatus as prime minister, Vladimir Putin proclaimed that his side had “ won an open and honest battle ” ( despite his election being anything but). Many things appeared to be going well. The population was growing and people were living longer, wealthier and happier lives. No longer. Over the past ten years Russians have begun to die younger, and are becoming fewer, poorer and more miserable.
The first hit was to the economy. The annexation of Crimea in 2014 was greeted with cheers in Russia. But it brought a wave of sanctions and triggered a collapse in oil prices. The subsequent recession hit the economy hard. Average incomes fell, especially for the poorest half of the population. Although GDP per person rebounded by 2018, median incomes did not. According to the Luxembourg Income Study, they were still some 10% lower than their 2012 peak in 2019, the last year for which estimates are available. The World Happiness Report, based on surveys asking people to rate how they feel about their lives, found that the mood in Russia has dipped. Since 2017 Russians have rated themselves as less happy than in 2012.
Then came the pandemic. Russia’ s official covid-19 death rate appears unremarkable. But those figures are misleading. According to The Economist’ s excess mortality estimates, its true death toll is among the world’ s highest. Some 1.2m people have died, about twice the rate in America, and nearly three times that in the EU. Combined with declining birth rates and migration, that means the country’ s population is smaller now than in 2012. In 2021 alone, the country’ s population dropped by 693,000, or about 0.5%.
The Russo-Ukraine war has only made things worse. Although casualty numbers are uncertain and few compared with deaths from covid-19, they have been mounting rapidly, already running into thousands, and the soldiers who die are mostly young. And sanctions, unprecedented in their scale and ambition, have hit the already strained economy. So far, the economic fallout has been less damaging than might have been expected, but most analysts expect it to worsen over the coming months. The IMF predicts a “ bad recession ”. The Institute of International Finance, a banker group, projects an economic contraction of 15%. That would undo the growth in real incomes over the past decade two times over.
All of which is bad enough. But when compared with the world as a whole, or even rich countries in particular, Russia’ s decline looks even worse. Over the past decade, GDP in advanced economies has grown by 22%; across the world as a whole it has risen by 41% ( both adjusting for price changes). Should projections of a 15% contraction be right, by the end of the year Russia’ s economy will be 7% smaller than in 2012. Russia has not just lost a decade of growth—be it in economics, health or happiness. It is moving into the past.
In most democracies, such an unenviable record would spell trouble for the person at the top. But with his opponents locked up or in exile, elections far from free and fair, and the media under his control, Mr Putin has less to fear. The same can not be said for those who live under his rule. ■
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The West has presented a united front against the invasion of Ukraine. But many people live in countries sympathetic to Russia
The West has presented a united front against the invasion of Ukraine. But many people live in countries sympathetic to Russia
Published since September 1843 to take part in “ a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress. ”
Copyright © The Economist Newspaper Limited 2022. All rights reserved. | business |
Go or no go? Bristol's first-in-class hopes | Bristol Myers Squibb will hope to have the first-in-class treatment for hypertrophic cardiomyopathy by the end of the month, if mavacamten can overcome safety concerns.
Three Chinese companies are also set to test what the FDA finds acceptable when it comes to patient diversity in trials, while TG Therapeutics ' Ukoniq faces an advisory panel decision on the efficacy of its combination drug U2 in chronic lymphocytic leukaemia.
With Revlimid generics expected later this year Bristol Myers Squibb is counting on the approval and then success of mavacamten, its cardiac myosin inhibitor for obstructive hypertrophic cardiomyopathy ( HCM). If mavacamten is a hit it will help justify the $ 13.1bn Bristol spent to acquire Myokardia in 2020.
HCM is a genetic disease that causes the thickening of heart muscles, obstructing blood flow. With no approved therapies a quick FDA green light might seem a given, but the approval decision has already been delayed by three months after the agency asked for more time to review the safety data.
Even if mava is approved the FDA is widely expected to request post-marketing data on morbidity and mortality. But Berenberg analysts are not expecting this to blunt take-up: they forecast peak revenues of $ 4bn in obstructive HCM, which should go some way to helping fill the gap of declining Revlimid sales.
Another one of the biggest expected approvals of the year is Alnylam’ s vutrisiran in polyneuropathy of hereditary ATTR amyloidosis. The RNAi therapy is the company’ s more convenient follow-on to Onpattro, which was approved in 2018.
Despite its every-three-weeks subcutaneous delivery, compared with Onpattro’ s similarly spaced infusions, some analysts suggest that use could be confined to newly diagnosed patients given the 90% compliance rate for Onpattro. Even so, vutisiran's consensus forecasts for 2026 sales are, at $ 1.8bn, double those of Onpattro for that year.
Three of April’ s FDA approval decisions involve China-based companies, but the regulator might have a surprise in store for at least two of these. Coherus/Shanghai Junshi and Akeso/Sino’ s respective toripalimb and penpulimab are up for approval in third-line nasopharyngeal carcinoma, but supporting data come only from China.
This was one of the facts that tripped up Lilly/Innovent’ s sintilimab in February after an advisory committee voted 14-1 against approval, citing the difficulty in generalising the study findings to the US population.
Given relatively niche indication of nasopharyngeal carcinoma toripalimb and penpulimab could still get approved. If they do, it will give a further steer on how the FDA might treat the other anti-PD- ( L) 1s with China-only data.
Thanks to a US bridging study supplementing two Chinese trials Huchmed should avoid some of the uncertainty around homogenous patient groups when surufatinib comes before the FDA.
Surufatinib, a treatment for pancreatic and extra-pancreatic neuroendocrine tumours ( NETs), has also showed impressive effectiveness, with two pivotal Chinese studies finishing early due to efficacy. The company's claim that surufatinib can treat NETs produced from any organ, if true, could give Pfizer’ s Sutent and Novartis’ s Afinitor some competition as these are effective in only 70% of NET patients.
A greenlight would mark Hutchmed’ s first approval outside China. The only sticking point might be the FDA's ability to complete manufacturing inspections, a hurdle that has tripped the likes of UCB and Sol-Gel, which are now respectively looking for approval for Bimzelx and Epsolay.
The FDA’ s advisory committees will be kept busy this month, with the first order of business being a look at Covid preparedness. While the adcom will not discuss specific vaccine applications, or cast votes, a recommendation for widespread fourth booster shots or vaccines for the Omicron variants will be a bonus for Moderna and Pfizer.
In contrast a review of the PI3K-delta class, which has read-across for an April adcom of TG Therapeutics ' U2 and Ukoniq, is unlikely to generate good news for those concerned. The FDA will be looking at Ukoniq's approved lymphoma settings, but also its worrying lack of survival benefit when combined with ublituximab in chronic lymphocytic leukaemia.
As for the wider PI3K-delta inhibitor class, many have been given accelerated approval based on single-arm studies. The agency will now decide if randomised data should be the standard for approval, and has already rejected MEI’ s zandelisib.
The tables below lists first-time and supplementary US approval decisions, as well as advisory committee meetings, due next month, with consensus forecasts from Evaluate Pharma. | general |
Frédéric Leroux: « Is This The Dawn of a New Economic Order? » | Russia’ s invasion of Ukraine is a decisive event with major implications, initially humanitarian and subsequently economic. It caught the vast majority of western observers off guard – including asset managers like us, Frédéric Leroux writes in an essay on finews.first.
This article is published on finews.first, a forum for authors specialized in economic and financial topics.
Russian debt instruments lost between 60 percent and 80 percent of their value almost immediately after the invasion. Russian companies listed in the U.K. – mainly banks and producers of oil and other industrial commodities – saw their stock prices fall 92 percent to 99 percent between 16 February 2022 and 1 March 2022, the last business day before trading was suspended. At the same time, natural gas prices in Europe temporarily shot up by a factor of 2.5 and oil prices jumped by 55 percent.
This large, nearly instantaneous price adjustment can be explained by two distinct factors.
The first is western countries’ economic sanctions against Russia; these have included introducing a U.S. and U.K. embargo on the purchase of Russian oil and gas, expelling certain Russian banks from the SWIFT international payments system – meaning account holders can’ t receive payment for their sales – and freezing the assets that Russia’ s central bank holds abroad.
« The sanctions will weigh heavily on Russia’ s economy and could rapidly bring it to a standstill »
Moscow has taken a series of retaliatory measures in response. Russian companies soon won’ t be able to make debt payments in any currency other than the rouble, and the government may ban the export of some commodities – which could engender more bottlenecks in global supply chains.
The sanctions will weigh heavily on Russia’ s economy and could rapidly bring it to a standstill. And the direct effect of those sanctions, coupled with the retaliatory measures, will also impact the rest of the world and accentuate two trends that had started before the conflict: rising inflation and slowing economic growth.
« This also reflects society’ s new aspiration to an economy that’ s more ethical »
The second factor is the growing movement by investors around the world to incorporate environmental, social, and governance ( ESG) criteria into their investment decisions, as part of efforts to promote sustainable finance. Asset managers who have committed to socially responsible investing – a category that includes us at Carmignac – can not now keep investing in Russia as if nothing has happened. The most reasonable and legitimate response is to refrain from purchasing any Russian assets until further notice.
This is the path taken by us and a number of other investors, putting additional downwards pressure on the prices of Russian securities and causing them to depreciate much further than would be warranted by the sanctions alone. It also reflects society’ s new aspiration to an economy that’ s more ethical and puts less of a priority on the immediate financial gains which had driven so many economic decisions in past decades.
« These shifts will underpin higher prices for years to come before the benefits start to be seen »
Asset managers’ ESG commitments are also pushing up energy prices and speeding the transition to renewable energy. These commitments, coupled with the sanctions, retaliatory measures, and moves by western multinationals to pull out of Russia, are already giving us an indication of the war’ s potentially devastating consequences on the global economy. This could have the advantage of bringing about a negotiated resolution to the conflict more quickly.
The major political decisions being taken in response to the tragic event will come with a considerable economic cost. They could also fuel inflation by expanding the range of price drivers, such as a swifter transition to renewable energy, higher defense spending, new energy procurement routes, and the repatriation of production plants. These shifts will underpin higher prices for years to come before the benefits start to be seen in terms of economic efficiency.
« The new order will be based on the de-integration of global economies »
Viewed from this perspective, the war in Ukraine marks the end of a four-decade-long trend of disinflation caused by extensive globalization and favorable demographics and is ushering in a new economic order. The new order will be based on the de-integration of global economies as countries erect barriers and prioritize energy and manufacturing independence – an issue which the pandemic and now the geopolitical tensions have propelled to the top of the agenda.
This long-term trend reversal from disinflation to secular inflation will restore the appeal of long-forgotten sectors of the old economy, provided that the many constraints involved in bringing them back on domestic soil are rationally assessed. Many of today’ s technological advancements should help restore these sectors and give them a formidable level of economic efficiency, at the end of the day. The world after COVID-19 and the invasion of Ukraine?
Frédéric Leroux is a member of French asset manager Carmignac’ s strategic investment committee.
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Design Group – Strong through the pandemic | Whether it’ s Christmas cards, decorative candles or wall decorations - when it comes to artistically designed gifts or their packaging, it’ s hard for customers in the USA, Europe or Australia to avoid products of the Design Group.
In 2018, the company decided to implement a supply chain management software to bring transparency to its supply chain. Choosing from several companies, the choice fell on OSCA from software specialist Setlog.
This way, the company was well prepared when the pandemic hit. In fact, the consumer goods manufacturer managed the Covid-19 crisis really well and was able to adapt fast and easy.
This was mainly due to flexible partners, a fast IT department and the advantages of Setlog’ s software OSCA. As John Yablonski, Enterprise Applications Director at Design Group, says: `` OSCA enables us to always have visibility into inventory, deadlines and cash flow. ''
The right SCM software not only digitizes processes but also provides an essential competitive advantage. Be prepared for everything in your supply chain!
Click here to download the case study for free.
Please CLICK HERE to download the white paper. | general |
Yet another gene therapy developer turns to layoffs | Gene therapy holds great promise, with the potential to effectively cure an array of diseases. Already, the Food and Drug Administration has approved two of these medicines, Roche's Luxturna and Novartis ' Zolgensma, the latter of which was developed at AveXis. Yet, as with most cutting-edge technologies, there have been challenges, among them that gene therapies can be costly to develop and are difficult to manufacture.
For young companies like Taysha, these challenges were eased by easy access to money. The last few years had seen the biotechnology sector flushed with record amounts of capital from venture firms and the public markets. Taysha, notably, priced shares at the top end of the company's estimated range when it went public in September 2020, raising $ 157 million in the process.
But investor sentiment toward biotechnology companies, which reached new heights in the early stages of the coronavirus pandemic, has worsened substantially in recent months. While the downtown has affected drugmakers in all areas of research, it's been hard on those developing gene therapies. In addition to Taysha, at least ten other gene therapy developers have announced layoffs, cost cuts or restructured programs since December.
Taysha's current priorities are to advance one program targeting Rett syndrome, which is in preclinical testing, and another focused on giant axonal neuropathy, which is currently in an early-stage study that should produce results later this year. The company noted, too, that it expects to hit milestones this year in programs for two types of Batten disease and a rare form of infantile epilepsy.
But elsewhere, Taysha is cutting back. A small trial testing one of its therapies against Tay-Sachs disease will stop enrollment, for example, though patients who were previously dosed will continue to be followed.
`` To increase operational efficiency, activities for other ongoing clinical programs will be minimized and all additional research and development will be paused, '' Session said in a statement Thursday.
Taysha announced the layoffs and strategic changes alongside fourth quarter and full-year earnings. The company spent $ 132 million on research and development last year, and ultimately tallied a $ 173 million loss from operations. Session said that, with existing cash, debt financing and the newly implemented strategy, Taysha should have enough money to operate into the fourth quarter of 2023.
Taysha shares were up as much as about 3% Friday morning, before dipping down to near $ 6.50 apiece.
Topics covered: Pharma, biotech, FDA, gene therapy, clinical trials, drug pricing and much more.
At an industry conference Monday, a group of venture investors noted changes in how long biotechs are taking to raise money, and a shifting outlook among investors who specialize in shepherding young companies to an IPO.
Despite tumbling biotech valuations, however, several said they still prefer smaller-sized `` bolt-on '' deals to larger, potentially more disruptive, transactions.
Topics covered: Pharma, biotech, FDA, gene therapy, clinical trials, drug pricing and much more.
Topics covered: Pharma, biotech, FDA, gene therapy, clinical trials, drug pricing and much more.
At an industry conference Monday, a group of venture investors noted changes in how long biotechs are taking to raise money, and a shifting outlook among investors who specialize in shepherding young companies to an IPO.
Despite tumbling biotech valuations, however, several said they still prefer smaller-sized `` bolt-on '' deals to larger, potentially more disruptive, transactions.
Topics covered: Pharma, biotech, FDA, gene therapy, clinical trials, drug pricing and much more. | tech |
School is back in Japan. At last, so are foreign students. | For Misha Awad, the process of boarding a plane to Japan and then going through immigration brought with it a range of emotions — shock, nervousness, bureaucracy-induced tedium and even amusement.
While moving to a new country is a major step in anyone’ s life, Awad’ s case had an extra layer to it, as it was also the culmination of a long wait to return to Japan.
A student at the Inter-University Center for Japanese Language Studies ( IUC) in Yokohama, she and many fellow members of her program were finally able to enter the country in mid-March, having previously had their hopes dashed at the end of November, when their permission to enter Japan was canceled just days before they were supposed to fly due to tightened restrictions following the discovery of the omicron variant.
“ Knowing for sure I had made it to the gates, I don’ t need any of these papers ( for immigration) anymore, I’ m actually here — that was kind of just mind-blowing, ” she said.
Following the easing of Japan’ s strict border controls on March 1, which have been in place for most of the pandemic, at least some foreign students have been able to arrive in time for Friday’ s start of the academic year. For universities, researchers and students, that’ s a welcome and long-overdue change after a prolonged period of waiting and remote learning and research that came at great cost.
For fellow IUC student Cassidy Charles, her arrival brought feelings of relief, not least because of a last-minute scare after her domestic connecting flight was canceled due to bad weather, meaning she couldn’ t get on the actual plane to Japan. While she was able to fly out to her new home the next day, the cancellation set off a scramble to secure a new seat and get tested for COVID-19 again — all the while contending with the fear that this setback might scupper her chance to enter Japan.
“ When I was able to get my bags and leave, I was like, ‘ Oh my god, I did it. I can go to sleep now. Like I don’ t care what else happens, like the world could explode right now, but I have done it, I’ m done,’ ” she said.
In total, 31 IUC students arrived in March, joining the 13 who were already in Japan, while seven remained outside the country of their own volition. For those who did travel, bureaucratic confusion was a common occurrence, with consular or embassy officials often misunderstanding the students’ situation and the documents they needed — incidents that were fortunately cleared up quickly after the IUC reached out to its Foreign Ministry contacts.
IUC’ s fourth and final term began Monday, and due to ongoing COVID-19 measures, online learning will continue even for those in Japan. The IUC has been satisfied with the results of that arrangement, even when students have been stuck outside the country.
“ We did follow up on students last year during the pandemic. We compared their test scores in a variety of areas at different stages in the program with the test scores from previous cohorts and came up with fairly concrete indices that showed that, well, they didn’ t do 100% as well as students in the past, but they did like 80% as well, ” said Bruce Batten, the resident director of the IUC. “ So even online, I think things went pretty well. ”
Nonetheless, the center is planning in-person extracurricular activities for students, and Batten stresses that immersion in Japanese makes a real difference, particularly in terms of having the language stick.
Away from class, students have been able to re-engage with their Japan connections. Awad, who has had two previous stints in Japan, has finally reunited with her partner and thrown herself back into a number of community-driven projects she is involved with. Charles, meanwhile, has been able to see the family she stayed with in Hokkaido when she was 15 and is particularly close to — the wait to enter the country saw her miss the birth of two girls in the family.
“ Just being in Hokkaido being able to see my family again and see my nieces, that was the best part ( of coming back), ” said Charles. “ It’ s been great to be reconnecting with people. ”
A passenger walks past a flight information board at Haneda Airport in Tokyo on March 2. | AFP-JIJI
Although the arrival of the IUC cohort coincided with that of other students, and the group benefited from eased quarantine rules that followed the relaxation of Japan’ s entry ban, the center’ s connections with the Foreign Ministry enabled the group to gain entry under a condition of “ special exceptional circumstances, ” which is intended to facilitate the arrival of students whose presence in Japan is deemed by the government to be in the public interest. That meant they would have been able to enter Japan even if the ban had not been eased.
But even though the lifting of the ban has widened to cover entries beyond those such as IUC students, some are still waiting for their turn.
One of them is Chen Yian, a doctoral student at the University of Tokyo who lives in Taipei. Nonetheless, she remains positive about the situation.
“ I have already registered my information into the system they provided, so I suppose in a month I will be able to get in, but the process is still going on and I am still waiting for ( the Japanese government’ s) response, ” she said. “ Now that we can actually get in it’ s good … because some of our senpai ( seniors) are still in Taiwan in their second year of ( their) masters. ”
All the same, Chen has had to contend with bureaucracy and the slow, low-key way updates and changes are communicated.
“ They just update things on the website, and they don’ t really even promote what they updated — they just quietly update things, and we have to look it up for ourselves. ”
A figure for just how many students were able to arrive in March is expected to be announced later in April. While the government has raised its cap on the number of people who can enter Japan each day — a figure that includes Japanese nationals and returning foreign residents — and since mid-March has begun to prioritize foreign students within that framework, it will likely be the end of May before most students have entered.
Even after arriving in Japan, the entry ban still has had a lasting effect on students and their feelings about the country, particularly as a long-term home.
“ I do think that my certainty about being here has wavered because of the situation, ” Awad said. “ It’ s been around two years of just not knowing what’ s going to happen or if I should try, and knowing that that’ s the baseline for how I can be treated, that’ s really scary. And I don’ t think that’ s what I would want for myself, I don’ t think that I would want a place that I would call home to be a question mark.
“ I got to come back here because of a lot of privileges, ” she added. “ I think it’ s important to consider the fact that for a lot of people … they never get that opportunity that they deserve. ”
For Charles, the entry ban has had a similar effect — she talks of how the wait induced by the entry ban brought about a feeling of “ otherness. ” Still, the chance to act on the opportunity she had envisaged, as well as escape America’ s political and social conflicts, gun crime and high cost of health care, ultimately trumped those concerns.
While Japan eventually relented on its strict entry controls in the face of pressure from the business and academic communities, the longer-term lessons the government and country have taken from this episode are as yet unclear. But for Batten, he hopes it will lead to a more transparent and welcoming immigration system.
“ Japan really needs all of the friends that it can have, ” he said, pointing to the increasingly challenging security environment around the country.
“ I really hope that for everybody, this is a turning point and a learning moment that things like this don’ t work and they do more harm than good for everyone involved, ” Charles said. | tech |
'Hybrid immunity ' gives best COVID-19 protection, studies say | People with the “ hybrid immunity ” of having been both fully vaccinated and previously infected with COVID-19 have the strongest protection against the virus, two new studies said Friday.
After two years of a pandemic that has seen nearly 500 million people infected and billions vaccinated, the studies highlighted the importance of getting vaccinated for those who have natural immunity after recovering from the disease.
One of the two studies published in The Lancet Infectious Diseases medical journal analyzed the health data of more than 200,000 people in 2020 and 2021 in hard-hit Brazil, which has the world’ s second-largest COVID-19 death toll.
It found that for people who have already had COVID-19, Pfizer and AstraZeneca’ s vaccines offered 90% effectiveness against hospitalization and death, while China’ s CoronaVac had 81% and Johnson & Johnson’ s one-shot vaccine had 58%.
“ All four of these vaccines have proven to provide significant extra protection for those with a previous COVID-19 infection, ” said study author Julio Croda of the Federal University of Mato Grosso do Sul.
“ Hybrid immunity due to exposure to natural infection and vaccination is likely to be the norm globally and might provide long-term protection even against emerging variants, ” Pramod Kumar Garg of India’ s Translational Health Science and Technology Institute said in a comment piece linked to the study.
Meanwhile, a study using Sweden’ s nationwide register up to October 2021 found that people who recovered from COVID-19 retained a high level of protection against reinfection for up to 20 months.
And people with hybrid immunity based on two doses had a further 66% lower risk of reinfection than those with just natural immunity.
Paul Hunter, a professor in medicine at the University of East Anglia who was not involved in the study, said that the 20 months of “ very good protection ” from natural immunity was “ far better than we would expect for the original two-dose vaccine schedule. ”
But he cautioned that both studies were completed before the omicron variant became dominant across the world, and that it had “ notably dropped the protective value of a prior infection ”.
A study in Qatar published on the medRxiv pre-publication website last week gave an insight into the protection offered by hybrid immunity against omicron.
It found that three vaccine doses had 52% effectiveness against symptomatic infection of the BA.2 omicron subvariant — but that number jumped to 77% when the patient had been previously infected.
The study, which has not been peer reviewed, found that “ hybrid immunity resulting from prior infection and recent booster vaccination confers the strongest protection ” against both the BA.1 and BA.2 subvariants. | tech |
Governments want COVID vaccine-makers to aim higher in hunt for better shots | As governments prepare to live with COVID-19, some are questioning how much to rely on drugmakers to adapt vaccines to ward off future virus variants amid signs of tension between companies and regulators over the best approach, according to several sources familiar with the matter.
Some vaccine experts say government agencies should fund and help develop a new generation of COVID-19 shots and seek innovation from smaller developers, as they did to identify current vaccines.
“ We have established a research infrastructure that could do this relatively reasonably rapidly if we primed the pump and created the same kind of plan for second-generation vaccines as we did for the first-generation vaccines, ” said Dr. Larry Corey, a virologist who is overseeing U.S. government-backed COVID-19 vaccine trials.
BioNTech SE and Pfizer Inc., who developed the western world’ s most widely used COVID-19 vaccine, recently clashed with the European Medicines Agency ( EMA) over the best strategy for developing a new vaccine against the omicron variant, and whatever may follow, said two sources familiar with the matter.
An EMA spokesperson said the agency, along with other regulators, are encouraging companies to explore vaccines that target multiple variants.
In January, BioNTech and Pfizer began testing a vaccine designed to target omicron alone, believing the best approach is to tackle one major new variant at a time.
They had said a modified vaccine may not be necessary even after the emergence of the highly mutated omicron late last year led to a record surge in infections.
EMA regulators pressed the drugmakers to give equal priority to a vaccine targeting multiple variants, figuring that would offer broader protection against future mutations, the sources said. One of the sources said EMA would not signal whether the current vaccine trials will be enough to warrant approval even if the companies demonstrate safety and immune response.
On Wednesday, BioNTech said the companies would broaden their trial to test a shot targeting omicron and the original version of the coronavirus.
BioNTech said it decided to test a combination shot to scientifically validate decisions on the best vaccine strategy for the near future.
A BioNTech spokesperson declined to comment on the company’ s discussions with EMA. A Pfizer spokesperson did not respond to requests for comment.
Moderna Inc., which has also enjoyed great success with its COVID-19 vaccine, is testing a shot that targets omicron and the original coronavirus, aiming to have it ready in the fall.
“ We believe this may lead to the best breadth in protection, ” top Moderna scientist Jacqueline Miller said at a company event this month.
GlaxoSmithKline PLC is also working with German biotech CureVac AG on a vaccine that targets multiple coronavirus variants.
European and U.S. public health officials are pushing for better tools to fight COVID-19. Current vaccines are very effective against severe disease and death, but no longer against transmission, and immunity levels tend to wane within months.
Some health officials question whether companies that have reaped tens of billions of dollars from first-generation COVID-19 shots and stand to earn billions more from repeated boosters are willing to spend the money to find vaccines offering much broader and longer-lasting protection, which could take years.
Pfizer and BioNTech say their decisions are led by scientific findings.
Any new and innovative approach may come from smaller companies that will need funding for early development work, said Corey, from Seattle’ s Fred Hutchinson Cancer Center.
“ We need to do better, and we need to fund that, ” Corey said, adding that a new generation of COVID-19 vaccines could be supported by about $ 2 billion in funding.
The European Union made a massive bet on future Pfizer-BioNTech shots in a deal worth up to €35 billion ( $ 39.04 billion). That agreement requires the drugmakers to revise their shots to deal with new variants.
EU member states have also expressed interest in shots targeting multiple variants.
“ The message they’ ve sent to the companies is ‘ give us more options, ' ” one of the sources familiar with the matter said.
The international Coalition for Epidemic Preparedness Innovations, which helped fund early research into some existing vaccines, has $ 200 million available for next-generation vaccine research. It has awarded small grants to manufacturers including the U.K.’ s DIOSynVax and MigVax Ltd. of Israel.
Among the major Western COVID-19 vaccine-makers, Pfizer and BioNTech appear furthest along in redesigning their shot.
In late January, they launched a clinical trial testing immune responses to a vaccine targeting omicron in unvaccinated people, and as a booster in those fully vaccinated. Results are expected in April.
BioNTech has argued that laboratory analyses by other researchers showed that exposure to omicron in previously vaccinated people leads to a broad immune response against major prior coronavirus variants, the sources said.
Lab tests of a BioNTech-Pfizer shot targeting the earlier alpha and delta variants yielded an immune response inferior to what would be expected from a single-variant vaccine, they added.
A combination vaccine could raise other difficulties, including exacerbating temporary side effects seen with current shots, GSK said. Cutting the dose to avoid that could jeopardize efficacy, but GSK said it was working on that. | tech |
Organizer Chris Smalls clinches union win for Amazon workers — Quartz | Amazon employees at a Staten Island, New York City warehouse voted by a roughly 10% margin to form a union this week, marking the first successful labor campaign at the retail giant. More than 2,600 employees voted to be represented by Amazon Labor Union, an independent union that came together within the past two years under the leadership of organizer Chris Smalls.
The historic win on April 1 came the same week that Amazon workers at a separate warehouse in Bessemer, Alabama voted against unionizing for a second time, according to initial tallies. In a statement, Amazon said it was disappointed by the outcome of the Staten Island vote, and that it was considering filing objections.
In recent years, Amazon has sought to quash unionization efforts across the country, spending millions of dollars on consultants focused on dissuading workers from organizing.
Organizing for the Amazon Labor Union began in March 2020, when Staten Island workers walked out over management’ s handling of the coronavirus pandemic. Amazon supervisor Chris Smalls, who helped organize the walkout, was fired soon after and set out to unionize workers at the warehouse.
Smalls and his fellow organizers solicited donations for the union through GoFundMe, found a pro bono attorney on Twitter, and raised awareness of their campaign through a TikTok account. Their efforts were part of a growing wave of worker activism across the US, but were met by plenty of pushback from Amazon. In a leaked memo obtained by Vice, Amazon’ s general counsel called Smalls “ not smart or articulate, ” and laid out a strategy to quell support for a union by making the former employee the face of it.
“ Ironically, he said to make me the face of the whole unionizing effort, so I said, ‘ OK, that’ s a good idea, ' ” Smalls told The City earlier this month. Two years after being fired, Smalls popped champagne outside the office of the National Labor Relations Board today, toasting “ the first Amazon union in history. ”
Now that the Amazon Labor Union has won the majority of workers’ votes, they’ ll have to fight for a contract—and such an endeavor may require a continued and expanded campaign, said former Economic Policy Institute president Larry Mishel.
While Smalls hasn’ t yet released a detailed list of what the union is seeking from Amazon, he’ s said they hope to lobby management to raise minimum pay to $ 30 an hour, compared to the current starting hourly wage of $ 18, and restore monthly productivity bonuses. Amazon spent $ 4.3 million on anti-union consultants in 2021, according to HuffPost. | tech |
Covid-19 hospitalizations hit a pandemic low in the US, HHS data shows |
Fewer people are hospitalized with Covid-19 in the United States now than at any other point in the pandemic, but hospitals and staff continue to feel the strain.
As of Friday, there are 16,138 people in the hospital with Covid-19 -- fewer than there have ever been since the US Department of Health and Human Services first started
tracking
in July 2020. Just 2% of hospital beds are currently in use for Covid-19 patients.
Previously, the lowest point was in late June 2021, just before Delta became the dominant variant in the country. Covid-19 hospitalizations reached a peak in January 2022 amid the Omicron surge, when more than 160,000 people were hospitalized with Covid-19 at one time.
How the next coronavirus variant could emerge
While the strain on the US hospital system directly related to treating Covid-19 patients has been significantly reduced, experts say that many hospitals are still burdened by staffing shortages and other patients who are coming in sicker after postponing care during the height of the pandemic.
`` I can't hear that ( data on Covid-19 hospitalizations) without shouting 'hallelujah ' because the stress and strain of the last two years has been so enormous, '' Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, told CNN. `` But there are a number of things going on now that continue to make hospitals and their staff very busy. ''
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She says hospitals expected an influx of patients who had delayed care, either by choice or because the hospital system couldn't accommodate them.
`` But I think it is that combination of having more people needing care than we had anticipated and having more staffing issues than we had anticipated that is really the biggest challenge right now, '' she said.
The broader snapshot of hospital capacity offers a stark contrast to the CDC's `` COVID-19 Community Levels '' map, which tracks new hospital admissions and beds in use specifically for Covid-19 patients.
The CDC map is nearly all green, with 95% of US counties considered to have a `` low '' community level of Covid-19.
But HHS data shows that more than three-quarters of inpatient beds are currently in use in hospitals across the country, and there are nine states where more than 80% of all beds in the state are occupied.
In about half of US counties, less than 10% of children ages 5 to 11 are fully vaccinated against Covid-19
Experts say it's important to monitor both broader hospital capacity and the burden specifically from Covid-19.
`` From an endemic Covid monitoring perspective -- at least that's where we hope we're heading -- we need to be able to tell whether we're in a state that requires public health measures, '' Dr. Stephen Parodi, national infectious disease leader for Kaiser Permanente, told CNN.
But the pandemic has dramatically shifted the way hospitals operate. Pre-pandemic, there was typically seasonal variation in how many beds were filled, with more patients expected during flu season in the winter and a lighter volume over the summer.
`` What's different now, since the pandemic, is essentially we're running full all the time, '' Parodi said. `` That calculation of a plan -- when it comes to staffing those beds, having the workforce available, the doctors, nurses, the support services like laboratory and radiology -- it's changing our thinking about what we need to plan for an entire year as opposed to just one particular season. ''
Parodi and others expect the continued strain on capacity to persist at least through the end of the year.
Overall since August 2020, there have been about 4.6 million total hospital admissions for Covid-19 in the US, according to data from the CDC. More than a third of hospital admissions have been among seniors age 70 and older.
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Black and Hispanic people have been hospitalized with Covid-19 at more than twice the rate of White people, and American Indians have been more than three times as likely to be hospitalized. | general |
Grayscale Lives in a Future Pandemic, Surveilling Memory, Saving Coral Reefs, and More | Sea of Tranquility Emily St. John Mandel Knopf, 2022 ( $ 25)
Peel away the speculative skin of Emily St. John Mandel's latest novel—the time travel, the moon colonies, the Möbius strip of a plot that, against all odds, holds together until the very last page—and what's left is something much more vulnerable: a story about grief. In this moment of unbearable negative space, of sputtering pandemic disruptions and mind-numbing stasis, Mandel has written a eulogy for our half-lived years.
Sea of Tranquility, which forms a loose triptych alongside Mandel's two most recent novels, The Glass Hotel and Station Eleven, opens with a scene of exile: It is 1912, and Edwin St. John St. Andrew, the recently banished son of a well-to-do British family, is “ hauling the weight of his double-sainted name across the Atlantic by steamship. ” His destination is the eastern coast of Canada. He has no concrete plans, no real sense of purpose, and eventually he will find himself on the other side of the country, wandering through a forest in British Columbia, where, in a flash of weirdness, the first hints of this novel's true scope in space and time are revealed.
In subsequent chapters the narrative hops from Edwin's story to almost present-day New York City ( where Mandel wrote this novel during the COVID pandemic, the sound of ambulance sirens surely at times a near-constant companion), then to a future moon colony, with multiple stops along the way. At first all that holds these disparate threads together is the sense that something is off, an almost imperceptible tear in the fabric of time. Eventually the threads begin crossing, and it becomes impossible not to keep reading to see how these story lines will converge.
The most visceral and immediate of the novel's narrative threads concerns a writer named Olive Llewellyn, who when we first meet her has temporarily left her family behind on one of the moon colonies to come to Earth for a book tour on the eve of a new global pandemic. To her credit, Mandel makes no effort at coyness—it is pretty clear that many of Olive's experiences mirror her own, from having to grind through countless bizarre interview questions ( “ What's your favorite alibi? ” one interviewer enthusiastically asks Olive, as though we all carry one around in our back pocket in case of emergencies) to the crushing weight of days spent on the road and the simple desire to just go back home. These passages alone are worth the price of admission, not so much for voyeuristic extrapolation about how much of this book is really disguised memoir but rather for the pitch-perfect descriptions of the writing life, both before and during COVID.
The past few months have seen the birth of what might be called the first full generation of pandemic-era novels—books such as Neal Stephenson's Termination Shock, Hanya Yanagihara's To Paradise and Sequoia Nagamatsu's How High We Go in the Dark. Whether these books were written before the COVID era or not, they are now destined to be read in the shadow of the present moment, just as any novel released between 2017 and 2021 that touched even tangentially on authoritarianism was inevitably read in the shadow of Trump.
In some cases, the plagues that haunt this new crop of books are little more than scenery, a kind of wry nod to the low-grade fear many of us have that maybe this is just what the future will look like: one vicious contagion after another. Sometimes they are a means to critique the maddening vulnerability of individual-centric societies struggling against calamities that require, more than anything, a communal response. In stories such as Lawrence Wright's The End of October, they are action-movie fodder: pathogens cast in the role of supervillains.
Mandel's work occupies the decidedly introspective end of this spectrum. As with her previous novels, there is no hard sci-fi in Sea of Tranquility, no detailed explanations of the biomechanics of disease or the physics of time travel. Occasionally a tracking device might make an appearance out of narrative necessity, or a character may briefly note the rules of the game before slipping through time, but all these descriptions are firmly subservient. It is the emotional and psychological consequences of these technologies and calamities with which the novel is chiefly concerned. When Olive sits on an airship with three masks over her face, terrified of bringing a new illness home to her husband and daughter, it is only tangential that the airship is traveling to the moon. When she trudges through yet another virtual lecture to a room full of holograms, every reader will be reminded of their last Zoom meeting and the vaguely dehumanizing sense of being ushered into a cheap facsimile of the world.
Many of Mandel's signature moves are here: the interweaving plotlines, the quietly dystopian setting and, of course, the deadly pandemic as narrative device. But perhaps more than all these things, the most common and powerful motif in Mandel's fiction is the adherence to the idea that art and beauty are necessary. Her characters might suffer from a great many maladies but none more soul-draining than aesthetic poverty, none more unendurable than grayscale lives.
Art seeps in through every seam of this story. As soon as Edwin arrives in Canada, he takes up painting classes. Violin notes echo through the centuries, as do the words of a novel within the novel. The work of Shakespeare makes a cameo, as it has before in Mandel's books. Art is the means by which characters decipher the secrets of their own existence, in some parts of the novel quite literally.
Perhaps this is why Sea of Tranquility, for all its narrative cleverness and sci-fi inventions, is at its core an emotionally devastating novel about human connection: what we are to one another—and what we should be.
Midway through the book a pandemic tears through the population, both on Earth and in the distant colonies, and several of Mandel's characters are forced into numbingly inward lives as depleted and fear-lacquered as so many of ours these past couple of years. It is the small details of this self-imposed cocooning, these hollowed-out moments, that cut deepest. The novel's most crushing scene, only a few lines long and told in passing, involves a young child deep into pandemic lockdown having a conversation with an inanimate object, trying to make friends. I have loved every one of Mandel's books ( full disclosure: she was kind enough to blurb my first novel), but none has hit a nerve quite the way this one did.
Despite this heaviness, Sea of Tranquility is a brisk read. At a line level, the verbs do much of the heavy lifting, and the overarching plot, which involves a vast time-travel bureaucracy, is deliciously and just a little disconcertingly addictive. There is constant movement both within scenes and in the grand sweep of the novel. As the pandemic rages still through the real world, some of the scenes will feel a little too close. But after so much time spent away from one another, after so much distancing, the closeness is in its own way a balm, a reminder that we were, even in our aloneness, together.—Omar El Akkad
Omar El Akkad is a Canadian-Egyptian journalist and author of the novels What Strange Paradise ( 2021) and American War ( 2017).
Like its prequel, the 2011 Pulitzer-winning A Visit from the Goon Squad, Jennifer Egan's newest book reads not quite like a novel or a short story collection but like a fragmentary work of fiction with many perspectives and styles. This time a technology called Own Your Unconscious—a headset that lets people revisit their memories or see someone else's—is the conceit that brings old and new characters together in New York, Chicago, the American Southwest, and elsewhere as they navigate grief, love, parenthood, sex, addiction and trauma. Funny, heartfelt and cerebral, The Candy House asks compelling questions about authenticity and privacy in the era of surveillance capitalism. —Adam Morgan
Ocean scientist Juli Berwald is adamant that Life on the Rocks is not an obituary. The threats to coral reefs are daunting and multilayered, but so, too, are the solutions. Berwald goes beyond the usual methods ( preservation, reef-safe sunscreen) to describe unlikely efforts by special-ops veterans turned reef doctors, marine scientists and a conglomerate candy company. One idea involves nebulizing seawater into clouds over reefs to reflect more of the sun's radiation. Each highly readable chapter leans toward optimism, but key questions go unresolved. Are corals resilient enough to withstand warming oceans, or are these “ success stories ” death rattles in disguise? —Maddie Bender
The arrival of the printing press was a complicated milestone for scientific communication. Wary of intellectual-property theft, information overload and underprepared readers ( Descartes decried “ the cavils of ignorant contradiction-mongers ”), early scientists sought to embrace print's possibilities while avoiding its pitfalls: Huygens published his discovery of Saturn's rings in an anagram; Galileo strategically distributed review copies of his work, elevating him to Medici court mathematician. History professor Nicole Howard's analysis offers startling glimpses behind the scenes of foundational scientific texts. —Dana Dunham | science |
SA data scientists want seat at boardroom table | Surveyed South African data scientists want a seat at the boardroom table, noting they are dissatisfied with their company’ s use of data analytics to inform decision-making.
This is one of the key findings of the Accelerating Digital Transformation report commissioned by SAS in 2021. The research delved into the state of data science across the globe, by assessing the impact of the pandemic, challenges faced and overall satisfaction with the analytics environment.
It is based on a survey of almost 300 global and local data professionals, with the quantitative portion of the research augmented with qualitative interviews with data experts.
It notes the work of data scientists has grown in importance since the onset of COVID-19, with many organisations accelerating digital transformation projects by using technology to improve business operations. More than 90% of respondents indicated greater importance and demand for their work compared to before the pandemic.
According to the research, digital transformation has accelerated significantly due to the pandemic, but the extra demands placed on data scientists by employers revealed significant barriers to effective working and high levels of job dissatisfaction in some areas.
For example, around four in 10 respondents were dissatisfied with their company’ s use of analytics and model deployment, while more than 20 barriers to effective working were identified, caused by the radical shift in the way companies deliver products and services.
This was backed by respondents noting that data extracted for data science purposes within the organisation was not used by business decision-makers, making it one of the main barriers they faced.
This, according to the report, suggests a problem with how analytical insights are used by organisations to inform decision-making. Among the recommendations, the respondents noted that, as people responsible for analysing and extracting value from data, data scientists should get a seat at the boardroom table.
“ There have clearly been more demands placed on data scientists as the pandemic has accelerated digital transformation projects that many organisations were planning anyway, ” says Dr Iain Brown, head of data science at SAS UK and Ireland.
“ A major source of frustration is finding a way for organisations to implement the insights from analytics projects and use them in their decision-making, which means giving data scientists a seat at the boardroom table might be a way forward.
“ Linked to this, we found concerns around support for data science teams and a lack of talent, which has been an issue for some time, with demand outstripping supply. ”
The report also highlighted some specific skills gaps – less than a third of the respondents reported having advanced or expert proficiency in program-heavy skills, such as cloud management and database administration. This is an issue given that use of cloud services is up significantly, with 94% saying they experienced the same or greater use of cloud since COVID-19 struck.
The amount of time spent on data preparation versus model creation is another challenge experienced by data scientists. Respondents spend more of their time ( 58%) than they would prefer on gathering, exploring, managing and cleaning data.
“ Organisations must realise that investing in a team of data scientists with complementary skills could reap huge value for the business, so the cost of hiring needs to consider the return on that investment as we move to significantly more digital and AI-driven business processes, ” noted Brown.
The research also identified gaps in consistent organisational emphasis on artificial intelligence ethics, with 43% of respondents indicating their organisation does not conduct specific reviews of its analytical processes with respect to bias and discrimination. Only 26% of respondents reported that unfair bias is used as a measure of model success in their organisation.
“ Data science should be represented at any boardroom table, to bridge the gap between the technical and business. However, everyone at the table should also be moving forward towards analytics and recognise its importance, ” says Kelly Lu, lead on advanced analytics and artificial intelligence at SAS South Africa.
“ Although we have come a long way and many organisations are aiming to become more data- and analytics-driven, data scientists complain about their colleagues sometimes ignoring the analytics or overriding decisions based on gut feel or experience. While this can be very frustrating, it’ s something firms can overcome with effective communication and better collaboration. ” | general |
Roundup: AI COVID screening tool launched at Bangalore International Airport and more briefs | The Kempegowda International Airport in Bangalore, India has officially launched an AI screening tool for detecting COVID-19 and other communicable diseases by Corporeal Health Solutions, a Chennai-based provider of AI health tech solutions.
CHS, in partnership with the Indian Radiological and Imaging Association ( IRIA), is enabling this through its screening system called CHOCO – which identifies abnormalities in chest x-rays and provides results within `` nanoseconds, '' a news report noted. According to the company's website, its technology has a baseline accuracy of 91%.
`` During the pandemic, we observed the problems faced in the screenings at the entry and exit ports and saw the need for a solution that was faster and economically viable, '' said Dr Mona Bhatia, coordinator of the AI committee at IRIA.
In a four-week pilot study done by IRIA with over 1,500 volunteer passengers, the screening process using CHOCO only took five minutes per person, reducing standard passenger waiting time and ensuring a queue-free airport environment. The system was also found to detect communicable diseases in asymptomatic passengers.
Indonesia-based EMC Healthcare, the private hospital business of media company EMTEK Group, has chosen global IT provider InterSystems to digitise healthcare information in its network.
According to a press statement, the hospital group will implement the InterSystems TrakCare hospital information system across its six hospitals, unifying the network under a single EMR system.
TrakCare will allow clinicians from any of the EMC hospitals to instantly and securely access their patients ' medical records. With all departments running the same system, patient wait times and potential errors will be minimised, InterSystems said.
The EMR system further enables patients to continue treatment for their chronic conditions at home through remote monitoring integration.
Additionally, TrakCare features a patient engagement solution that allows patients and their families or carers to access health records, book appointments, and take part in the care process.
`` The future of healthcare is digital, '' said EMC Healthcare CEO Jusup Halimi. In explaining their decision to partner with InterSystems, he said: `` Whether speeding up the patient’ s journey, enabling treatment at home, or using the latest medical equipment and AI tools, data is central ''.
`` EMC Healthcare is taking a giant leap forward by becoming a digital hospital group, '' Luciano Brustia, InterSystems ' managing director for Asia-Pacific, commented.
The SRM Institutes for Medical Science Hospital in Chennai, India has launched its Hello Doctor programme to offer home healthcare services with virtual care.
Based on a press statement, the programme offers both home healthcare service and acute care at home, guided by monitoring and treatment protocols.
While it will mainly cater to the elderly and children, Hello Doctor will also provide treatment for over 50 acute conditions at home, including asthma, chronic heart failure, pneumonia and lung disease.
The initiative, according to SRM Group Chairman Dr Ravi Pachamuthu, was created in response to their patients ' demand. `` It’ s a people’ s preference program equipped with a perfect combination of our best healthcare professionals and best of the technology to ensure the patient is not suffering any adverse consequences by maintaining oversight of him or her all the time ''.
`` With the launch of Hello Doctor initiative, SIMS is set to provide its proven quality hospital-level services beyond its existing walls and stays committed to ensure patients get the care they need in their home too, '' Thiru Ma. Subramaniam, Tamil Nadu's health minister, commented on the launch.
As part of Hello Doctor, SIMS Hospital launched a fleet of vehicles, as well as a helpline and a dedicated team of healthcare professionals to manage the programme. | tech |
COVID-19 tracker: Japan logs 49,266 new cases, up by 1,800 from last week | Japan reported 49,266 new cases of the coronavirus on Friday, with the daily count rising by some 1,800 from a week before.
There were 78 new fatalities among COVID-19 patients, while the number of severely ill patients dropped by 94 from Thursday to 533.
The Tokyo Metropolitan Government reported 7,982 new COVID-19 cases on Friday, up by 693 from a week before, along with nine deaths.
The number of severely ill COVID-19 patients under the metropolitan government’ s standards dropped by two from Thursday to 30.
The seven-day average of new cases came to 7,628.9, up from 6,275.4 a week earlier.
Elsewhere, Chiba Prefecture confirmed 2,561 cases and Okinawa Prefecture saw 1,125 cases.
The health ministry said Wednesday that the number of severely ill patients nationwide dropped by 94 from the previous day to 533.
On Thursday, Japan reported 51,913 new COVID-19 cases, with the daily count growing by about 2,200 from a week before.
Across the country, 102 new fatalities were confirmed among COVID-19 patients. | tech |
A cause for concern: China diplomacy targets Pacific nations | The leak of a draft security cooperation agreement between China and the Solomon Islands has alarm bells ringing in Honiara, the nation’ s capital, and beyond.
Provisions in the agreement, such as those that seemingly authorize the dispatch of Chinese forces to help control social unrest in the country, are especially worrisome.
Rather than complain, governments that are troubled, and Tokyo is among them, should pay more attention to local concerns. South Pacific nations are threatened by climate change and diminishing economic opportunities. They fear becoming pawns in the geopolitical competition between China and the West. Governments that fear Chinese encroachment should do more to address the issues that worry their residents to win favor in regional capitals.
The Solomon Islands are an archipelago of over 900 islands spread across some 1,500 kilometers in Oceania, east of Papua New Guinea and northeast of Australia. It is home to Guadalcanal, the site of one of the bloodiest battles of the Pacific War and a turning point in the war.
The country has periodically experienced violent protests — the product of deep social and political divisions. Such flareups occurred after general elections in 2006 and 2019, and more recently in November 2021 in an incident that was triggered by Prime Minister Manasseh Sogavare’ s decision to switch diplomatic recognition from Taiwan to China. Public anger was fueled by allegations of corruption — essentially that Chinese money purchased the move — and protestors focused their anger on Chinese businesses; four lives were lost in the violence.
Australia, the Solomon Islands’ traditional security provider, sent troops to help restore order at Honiara’ s request. Afterward, China sent 10 police officers and offered to help train and equip the nation’ s riot police.
That role anticipated arrangements in the security agreement. The document says the Solomon Islands may ask China “ to send police, armed police, military personnel and other law enforcement and armed forces … to assist in maintaining social order. ” China can also provide “ assistance on other tasks. ” The draft allows China to “ make ship visits to, carry out logistical replenishment in and have stopover and transition in the Solomon Islands. ” Those ships would be protected by Chinese troops. Both parties agreed to keep the agreement secret.
Domestic opposition to the pact reflected fears that Chinese forces would intervene on Sogavare’ s behalf and allow him to manipulate the 2023 general election. Foreign observers worry about the Solomon Islands’ democracy and the prospect of China gaining a foothold — a naval base — in a crucial location in the South Pacific. The Solomon Islands are part of the second island chain, which would be used to hem in Chinese military forces in a conflict; conversely, Chinese military facilities in these islands could be used to keep U.S. forces out of the region.
Sogavare acknowledged the existence of the pact and said it was ready for signing; he also labeled the charges that it could destabilize regional security as “ insulting. ” The nation’ s leader insisted that he had not been pressured to sign the agreement and had “ no intention ” to ask China to build a military base in the Solomons. His country’ s foreign policy, he added, was to be a friend to all, an enemy to none and to not be drawn into geopolitical conflicts.
There is more than a whiff of paternalism to complaints about China’ s growing influence in the Solomon Islands and throughout Oceania. To be sure, Beijing is using its wealth to buy influence and risks corrupting local politics. Taiwan is equally quick to use its money for political advantage, too.
Most importantly, however, for many Pacific islands residents and politicians, China is helping them address their problems. That means, first and foremost, providing funds for development. In 2014, Chinese President Xi Jinping visited Fiji and told a gathering of regional leaders that his country was prepared to help. China has honored that pledge, providing grants and loans of about $ 200 million a year. It has also become a key market for exports from those islands, taking in fish, wood products and minerals.
Other longtime partners have been playing catch-up. Earlier this year, U.S. Secretary of State Antony Blinken visited the region, confirming that the U.S. has “ a long-term future in the Indo-Pacific, ” promising to re-open an embassy in the Solomon Islands. — the previous one closed in the 1990s — and pledging more U.S. help on climate change, COVID-19 vaccines and illegal fishing.
In 2020, the U.S. announced more than $ 200 million in regional assistance, including for development aid and to help deal with the pandemic. Regional leaders are eager to have that U.S. presence but they are wary. Washington’ s attention has been sporadic and even with the purported Chinese threat, its actions continue to be slow.
Oceania is a long way away from the United States, but that doesn’ t mean that China will fill the gap. Rather, Australia, New Zealand and Japan should step up. Australia has been the most visible source of support. In fiscal 2020-2021, its development assistance to the region reached $ 1.4 billion Australian dollars ( a little over $ 1 billion) and was set at a similar level for 2021-2022.
Japan plays an important role as well. A 2019 study by the Lowy Institute, an Australian think tank, identified Japan as the sixth largest donor in the region, having provided more than $ 1 billion in aid between 2011 and 2017. In 1997, Japan set up the Pacific Islands Leaders Meeting, which meets every three years. In July 2021, Japan joined a UNICEF initiative, providing $ 20.8 million to Pacific Island governments for COVID-19 preparedness and response efforts.
The best solutions will be multilateral. In 2018, Japan, Australia and the U.S. launched the Trilateral Partnership for Infrastructure Investment in the Indo-Pacific. It has financed just one project so far: a $ 30 million fiber-optic cable linking Australia, Palau, Papua New Guinea and the Solomon Islands. It’ s a start but only that. Failure to do more makes Sogavare’ s deal with China look better every day. | tech |
Global Data Integration Market By Component, By Business Application, By Deployment Type, By Enterprise Size, By End User, By Regional Outlook, Industry Analysis Report and Forecast, 2021 | The Global Data Integration Market size is expected to reach $ 22.1 billion by 2027, rising at a market growth of 10.4% CAGR during the forecast period.The process of combining the data from various sources into a single unified view is called data integration. The data integration starts from the process of ingestion which includes various steps such as mapping, cleansing, transformation and ETL. Data integration helps the analytics tools in producing actionable and effective business intelligence. The data integration market includes data integration of services and tools which are used for combining the data from separate sources and delivering the integrated data.The focus of data integration solutions is shifting towards cloud-based integration solutions for the users. This is because a number of organizations have shifted to a private or public cloud. Moreover, the providers of cloud-based services and solutions including Microsoft, IBM, and SAP are focused on designing the cloud software which includes the on-premise application.In the modern era, a rise in the demand for cloud computing technology can be seen. This is because it helps in collecting data from separate sources like distributed servers, remote sensors, and the web. Also, with the help of that data, the organization can get valuable insight. There is a need to have advanced big data integration tools in order to capture & integrate the massive amount of data collected from different internal as well as external sources. Such tools can efficiently fulfill the need of an organization by permitting the organization to strengthen the data pool by integrating from the cloud as well as on-premise data transferred to the cloud.Data plays an important role in the organization due to the ever-increasing volume of data that is collected from different sources. Most business organizations are willing to adopt different strategies in order to use the data for their benefits.COVID-19 Impact AnalysisThe outbreak of COVID-19 has affected all the business operations in one or another manner. The pandemic has put various challenges in front of the many business enterprises and also served as an opportunity for digitalization. Many offices, schools and colleges have adopted the online mode of working which also led to the digitalization of various activities. The retail and production sector has faced a decline in business due to the imposition of lockdown and restriction over exports and imports of goods.Whereas, the data integration market has witnessed significant growth during this pandemic. This is because many organizations have shifted towards cloud deployment & on-premise deployment. Due to this, it has become essential for organizations to modify their existing strategies and adopt data integration.Market Growth Factors: Reduce the operational costBy implementing an efficient integration platform, the organization is not required to waste resources on managing individual software which ultimately reduces the cost. Also, the use of data integration reduces maintenance costs. An efficient data integration technology enables the business organization to empower their systems to work to provide a better experience instead of wasting money and other resources on incapable technologies.Rise in technological advancementsThe continue development in the world is leading towards the rising demand for more advanced technologies in order to facilitate different types of tasks. Also, with the widening customer base as well as expansion of the regional markets, many organizations are struggling to deal with the broad data sources. With the arrival of big data technology, enterprises are well aware of the advantages of implementing big data and are thus investing in data integration technologies.Market Restraining Factors: Poor Security and performanceThe security of confidential information is the topmost priority of any organization. Organizations are required to be sure that their data is stored on a secure platform. However, there is the risk of not having proper security for the organization using data integration tools. The data can be easily accessed from anywhere when it comes to the use of cloud-based data integration tools. This easy accessibility has benefits but also involves the risk of loss of revenue, data leakage, loss of trade licenses, data breach, loss of organizational reputation, government penalties & lawsuits.Components OutlookOn the basis of components, the data integration market is segmented into tools and services. In 2020, the tool segment dominated the data integration market by generating maximum revenue. The data integration tools are the software used for integrating the data. Such tools are developed according to the need of the organization. These tools are required to perform mapping, transformation & cleansing data.Business Application OutlookBased on business application, the data integration market is classified into marketing, sales, operations, finance, and human resource. The HR segment is expected to showcase a promising growth in the data integration market over the forecast years. The data integration enables the HR team to compare metrics of various sources at a single data source. Also, the data integration helps the HR team to identify the best sources for recruitments and the best way to optimize the performance as well as cost.Deployment Type OutlookBased on deployment mode, the data integration market is divided into cloud and on-premises. The cloud segment procured a significant revenue share of the overall data integration market in 2020. The aim of cloud-based data integration is to create a unified data store that can be efficiently accessed by all the relevant applications & users. Cloud refers to performing data integration tasks within a private or public cloud.Enterprise Size OutlookBy organization size, the data integration market is categorized into large enterprises and small & medium enterprises. In 2020, the large enterprise segment dominated the data integration market by generating maximum revenue. These are the enterprises with wider operations across different geographical locations along with high turnover. This is because these enterprises highly require data integration solutions as it would be difficult to combine wide data sources manually which are largely expanded.End User OutlookOn the basis of end user, the data integration market is fragmented into BFSI, retail and consumer goods, manufacturing, media and entertainment, energy utilities, telecom and IT, healthcare and life sciences, and government and defense. In 2020, the healthcare & life sciences segment dominated the data integration market with the highest revenue share. The existence of huge data, especially for the clinical, claims, hospital system, financial, patient, pharmacy, and wearable technologies in the healthcare and life science creates the need for data integration technologies across the segment.Regional OutlookRegion-wise, the data integration market is analyzed in North America, Europe, Asia Pacific, and LAMEA. In 2020, the North America emerged as the leading region in the overall data integration market by procuring the maximum revenue share. Moreover, these tools can also help in understanding the needs of customers, and promote effective co-operation in the team.The major strategies followed by the market participants are Partnerships. Based on the Analysis presented in the Cardinal matrix; Microsoft Corporation is the major forerunners in the Data Integration Market. Companies such as SAP SE, Oracle Corporation and IBM Corporation are some of the key innovators in the Market.The market research report covers the analysis of key stake holders of the market. Key companies profiled in the report include Precisely ( Clearlake Capital Group), IBM Corporation, Oracle Corporation, Microsoft Corporation, SAP SE, Talend S.A., Software AG, SAS Institute, Inc., Tibco Software, Inc. ( Vista Equity Partners), and Informatica, LLC.Recent Strategies deployed in Data Integration MarketPartnerships, Collaborations and Agreements: Dec-2021: IBM teamed up with MuleSoft, a software company that provides integration software for connecting applications, data, and devices. Through this acquisition, the company aimed to deliver increased integrations & solutions in IBM’ s product family to support financial services & other mutual consumers.Nov-2021: Microsoft partnered with Corelight, provider of the industry’ s leading open network detection and response. Through this partnership, the company aimed to leverage an open platform to share data to further enhance Microsoft Defender for IoT. In addition, consumers using Corelight can secure their entire IoT and OT environments with Microsoft 365 Defender and Defender for IoT within minutes while adding more detections based on encrypted traffic analysis & complementing Microsoft’ s MITRE ATT & CK coverageJun-2021: Microsoft teamed up with Wejo Limited, a global leader in the connected vehicle. Through the acquisition, the company aimed to advance the cutting-edge application of connected vehicle data across the globe.Jun-2021: Oracle joined hands with Deutsche Bank, a financial services organization. Through this collaboration, the companies aimed to enhance the bank’ s database technology and speed up its digital transformation by enabling data integration across its business to streamline operations, offer unified oversight of core service processes and deployments, and simply design & scale applications based on consumer demand.May-2021: SAP partnered with Siemens, a German multinational conglomerate corporation and the largest industrial manufacturing company. From this partnership, the companies aimed to enable a true digital thread that would integrate real-time operations-based data with virtual product and asset models utilize components from both Siemens and SAP to provide operational insights.Apr-2021: Microsoft joined hands with Informatica, the enterprise cloud data management leader. From this collaboration, the companies aimed to enhance consumers’ journeys to the cloud by utilizing Informatica Intelligent Data Management Cloud ( IDMC). In addition, consumers can process data loading and data integration use-cases for free using Informatica’ s industry-leading iPaaS service.Apr-2021: Software AG came into a partnership with Matillion, a data transformation solution provider or cloud data warehouses. This partnership aimed to support widespread cloud adoption and make it easier for businesses to digitally transform such that consumers can bring data from different sources together, creating a single source of truth from which to extract valuable business insights.Feb-2021: IBM entered into a partnership with Palantir Technologies, a public American software company that specializes in big data analytics. Through this partnership, the companies aimed to support businesses looking forward to increasing the value of a large amount of data which include those in retail, manufacturing, financial services, telecommunication, and healthcare.Feb-2021: IBM teamed up with Siemens, a German multinational conglomerate, and Red Hat, a leading provider of enterprise open-source solutions. Under this collaboration, Siemens Digital Industries Software would apply IBM’ s open hybrid cloud approach, built on Red Hat OpenShift, to extend the deployment flexibility of MindSphere, the industrial IoT as a service solution from Siemens. This collaboration enables consumers to run MindSphere on-premise, unlocking speed & agility in plant and factory operations as well as through the cloud for seamless product updates, support, and enterprise connectivity.Dec-2020: Talend came into a partnership with Snowflake, the cloud-based data-warehousing company. Under this partnership, Talend Trust Score would evaluate data stored on Snowflake’ s platform for reliability and also measure data health through intelligent diagnosis and resolve data integrity issues in multi-cloud environments. This partnership aimed to allow consumers to quickly mobilize their data to achieve better business outcomes, with clean, accessible, and governed data.Aug-2020: Informatica extended its partnership with Google Cloud. This partnership aimed at the joint go-to-market initiative to accelerate analytics with BigQuery and SAP on Google Cloud. Together, the companies would offer IICS and Data Integration Services to these organizations.May-2020: SAP came into a partnership with Informatica, an American software development company. From this partnership, the companies aimed to feature the adoption of SAP Data Warehouse Cloud, which would support integration with present data warehouses and a wide range of applications and databases on-premises and in the cloud.Product Launches and Product Expansions: Dec-2021: Precisely updated Data360 Govern, market-leading data governance solution. This updated solution would enable the organization to implement data scoring rules which measure the accuracy & completeness of the company’ s data in real-time, & take steps to increase data integrity with a quick time to value.Jul-2021: Informatica launched the industry’ s first enterprise-scale, seamless data governance, and catalog as-a-service. By this launch, the company aimed to help enterprises reimagine and renovate the company’ s data and analytics governance programs, the comprehensive solution brings together data cataloging, quality, data, and AI governance capabilities with unified metadata-driven intelligence natively in the cloud.Apr-2021: IBM introduced major innovations in its storage portfolio and launched updates to its IBM Elastic Storage System ( ESS) family. From this expansion, the company aimed to enhance the access and management of data across complex hybrid cloud environments for greater data availability & resilience.Apr-2021: Oracle added GoldenGate data integration service, a serverless offering that runs on the Oracle Cloud to its portfolio. From this expansion, the company aimed to provide an event-based approach for the integration of operational & analytic databases between on-premises data centers & any private, public or hybrid clouds.Dec-2020: Microsoft introduced Azure Purview, a new data governance solution. From this launch, the company aimed to minimize compliance risk & help consumers map all their data, no matter where it resides and provide an end-to-end view of their data estate by automating the discovery of data.Dec-2020: Oracle introduced Oracle MySQL Database Service, a fully-managed Oracle Cloud Infrastructure service. This service would enable consumers to run sophisticated analytics directly against their operational MySQL databases without the need for complex data integration with a different analytics database.Oct-2020: Precisely unveiled Precisely Data Integrity Suite, a modular that offers high accuracy, consistency, and context in data for confident business decisions. Precisely Data Integrity Suite is the first suite to span the full spectrum of data integrity, delivering accuracy and consistency through best-in-class data quality & data integration abilities, & context through market-leading location intelligence & data enrichment.Acquisitions and Mergers: Oct-2021: Microsoft took over Clear Software, an Intelligent Automation platform that protects and extends technology investments. Under this acquisition, ClearProcess would permit automation applications & workflows to better sync with enterprise resource planning platforms and a similar system of record and also enables centralized access of data of all employees.Jun-2021: Precisely along with TA Associates announced the acquisition of Winshuttle from Symphony Technology Group, an American private equity firm based in Palo Alto, California. Through this acquisition, the company aimed to expand its integrity software solution set into process automation & master data management software, which are both top priorities on its product roadmap.May-2021: Precisely signed an agreement to acquire Infogix, a data integrity and governance software provider. From this acquisition, the company aimed to add another dimension to data integrity and enable data governance by bringing technical, business, relationship, and usage intelligence of Infogix about data into its portfolio.Oct-2020: TIBCO signed an agreement to acquire Information Builders, a leading data and analytics software company. This acquisition aimed to enhance its Hyperconverged Analytics strategy and support its Any Data Hub and Responsive Application Mesh strategies by leading data quality, preparation, integration products, and WebFOCUS.Jun-2020: Microsoft signed an agreement to acquire ADRM Software, a leading provider of large-scale industry data models. By this acquisition, the company aimed to permit the creation of the intelligent data lake where data from various lines of business would be harmonized together in less time.Scope of the StudyMarket Segments covered in the Report: By Component• Tools and• ServicesBy Business Application• Marketing• Sales• Operations• HR and• FinanceBy Deployment Type• On-premise• CloudBy Enterprise Size• Large Enterprises• Small & Medium EnterprisesBy End User• Healthcare & Life Sciences• BFSI• IT & Telecom• Manufacturing• Retail & Ecommerce• Government and• OthersBy Geography• North Americao USo Canadao Mexicoo Rest of North America• Europeo Germanyo UKo Franceo Russiao Spaino Italyo Rest of Europe• Asia Pacifico Chinao Japano Indiao South Koreao Singaporeo Malaysiao Rest of Asia Pacific• LAMEAo Brazilo Argentinao UAEo Saudi Arabiao South Africao Nigeriao Rest of LAMEACompanies Profiled• Precisely ( Clearlake Capital Group) • IBM Corporation• Oracle Corporation• Microsoft Corporation• SAP SE• Talend S.A.• Software AG• SAS Institute, Inc.• Tibco Software, Inc. ( Vista Equity Partners) • Informatica, LLCUnique Offerings • Exhaustive coverage• Highest number of market tables and figures• Subscription based model available• Guaranteed best price• Assured post sales research support with 10% customization free
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Barrick Committed to ESG Leadership, Says Executive | TORONTO, April 01, 2022 ( GLOBE NEWSWIRE) -- Barrick Gold Corporation ( NYSE: GOLD) ( TSX: ABX) ( “ Barrick ”) – Good ESG management is essential to Barrick’ s vision of becoming the world’ s most valued gold and copper company, says executive chairman John Thornton in the company’ s 2022 Information Circular published today and available now at www.barrick.com/agm and also filed on SEDAR ( www.sedar.com) and EDGAR ( www.sec.gov).
The principles of ESG have long been entrenched in Barrick’ s commitment to partnership-based business objectives, a philosophy built on engagement, transparency and caring, which recognises the importance not only of the shareholders who own the company but also of its other stakeholders: employees, host countries, the communities around the mines and the company’ s business partners.
“ Our rigorous focus on performance and execution against our sustainability strategy enables us to develop and maintain trusted long-term partnerships with all stakeholders, ” says Thornton. “ In an industry first, we published an open and honest assessment of our actions in the form of a scorecard in our Sustainability Report in 2019. The third of these scorecards will appear in the 2021 Sustainability Report, to be published in the second quarter of 2022. Like its predecessors, the 2021 report will objectively track our progress against key metrics and highlight areas which need improvement, providing stakeholders with a valuable insight into this important part of our business, as well as demonstrating Barrick’ s commitment to ESG leadership. ”
Also in the Information Circular, lead independent director Brett Harvey noted that the Board was maintaining its focus on board renewal and diversity. Since the merger with Randgold, it has appointed six new directors, including three women. Female directors now form 27% of the Board and 33% of the independent directors.
“ Barrick’ s human capital strategy, including our approach to promoting diversity, continues to be a critical enabler of positive change, ” says Harvey. “ By prioritizing local employment – 96% of our employees are host country nationals – we naturally grow the ethnic and cultural diversity of our workforce. ”
Due to the ongoing public health concerns related to the global pandemic and to mitigate health risks to all stakeholders, this annual meeting will again be virtual. The company will monitor the situation closely and provide a physical location if conditions allow. The Information Circular details how to participate, how to vote and how to contact the Board and the company.
Barrick’ s 2022 Annual Meeting of Shareholders will be held on May 3, 2022 at 10:00 am ( Toronto time) at web.lumiagm.com/476307397. A live webcast of the meeting will also be available at www.barrick.com/agm.
Kathy du PlessisInvestor and Media Relations+44 20 7557 7738Email: barrick @ dpapr.com
Certain information contained or incorporated by reference in this press release, including any information as to our strategy, projects, plans or future financial or operating performance, constitutes “ forward-looking statements ”. All statements, other than statements of historical fact, are forward-looking statements. The words “ commit ”, “ vision ”, “ enable ”, “ develop ”, “ maintain ”, “ will ”, “ focus ”, “ promote ”, “ enable ” and similar expressions identify forward-looking statements. In particular, this press release contains forward-looking statements including, without limitation, with respect to: Barrick’ s vision to be the world’ s most valued mining company; the anticipated benefits of Barrick’ s sustainability strategy and Sustainability Scorecard; Barrick’ s focus on increasing Board and workforce diversity; and Barrick’ s intention to make a physical location available on May 3, 2022 for the Annual Meeting of Shareholders if circumstances related to Covid-19 allow.
Forward-looking statements are necessarily based upon a number of estimates and assumptions including material estimates and assumptions related to the factors set forth below that, while considered reasonable by the company as at the date of this press release in light of management’ s experience and perception of current conditions and expected developments, are inherently subject to significant business, economic and competitive uncertainties and contingencies. Known and unknown factors could cause actual results to differ materially from those projected in the forward-looking statements and undue reliance should not be placed on such statements and information. Such factors include, but are not limited to: fluctuations in the spot and forward price of gold, copper or certain other commodities ( such as silver, diesel fuel, natural gas and electricity); the speculative nature of mineral exploration and development; changes in mineral production performance, exploitation and exploration successes; diminishing quantities or grades of reserves; increased costs, delays, suspensions and technical challenges associated with the construction of capital projects; operating or technical difficulties in connection with mining or development activities, including geotechnical challenges and disruptions in the maintenance or provision of required infrastructure and information technology systems; failure to comply with environmental and health and safety laws and regulations; non-renewal of key licences by governmental authorities; changes in national and local government legislation, taxation, controls or regulations and/or changes in the administration of laws, policies and practices; expropriation or nationalization of property and political or economic developments in Canada, the United States and other jurisdictions in which the company or its affiliates do or may carry on business in the future; timing of receipt of, or failure to comply with, necessary permits and approvals; uncertainty whether some or targeted investments and projects will meet the company’ s capital allocation objectives and internal hurdle rate; lack of certainty with respect to foreign legal systems, corruption and other factors that are inconsistent with the rule of law; risks associated with illegal and artisanal mining; risks associated with new diseases, epidemics and pandemics, including the effects and potential effects of the global Covid-19 pandemic; damage to the company’ s reputation due to the actual or perceived occurrence of any number of events, including negative publicity with respect to the company’ s handling of environmental matters or dealings with community groups, whether true or not; the possibility that future exploration results will not be consistent with the company’ s expectations; risk of loss due to acts of war, terrorism, sabotage and civil disturbances; litigation; contests over title to properties, particularly title to undeveloped properties, or over access to water, power and other required infrastructure; our ability to successfully integrate acquisitions or complete divestitures; risks associated with working with partners in jointly controlled assets; employee relations including loss of key employees; increased costs and physical risks, including extreme weather events and resource shortages, related to climate change; and availability and increased costs associated with mining inputs and labor. In addition, there are risks and hazards associated with the business of mineral exploration, development and mining, including environmental hazards, industrial accidents, unusual or unexpected formations, pressures, cave-ins, flooding and gold bullion, copper cathode or gold or copper concentrate losses ( and the risk of inadequate insurance, or inability to obtain insurance, to cover these risks).
Many of these uncertainties and contingencies can affect our actual results and could cause actual results to differ materially from those expressed or implied in any forward-looking statements made by, or on behalf of, us. Readers are cautioned that forward-looking statements are not guarantees of future performance. All of the forward-looking statements made in this press release are qualified by these cautionary statements. Specific reference is made to the most recent Form 40-F/Annual Information Form on file with the SEC and Canadian provincial securities regulatory authorities for a more detailed discussion of some of the factors underlying forward-looking statements and the risks that may affect the company’ s ability to achieve the expectations set forth in the forward-looking statements contained in this press release.
We disclaim any intention or obligation to update or revise any forward-looking statements whether as a result of new information, future events or otherwise, except as required by applicable law. | general |
Fuji Rock 2022 lineup sees return of overseas acts | Fuji Rock, Japan’ s premier annual summer music festival for showcasing overseas artists, is returning to form after postponing the event in 2020 and pivoting to an all-Japanese lineup in 2021 due to the COVID-19 pandemic.
Organizer Smash announced the three-day festival’ s preliminary lineup Friday night, with American artists Jack White and Halsey set to appear as headliners. The third headlining act is yet to be announced. Other acts scheduled to perform include electronic artists Bonobo and Mura Masa, rock groups Foals and Dinosaur Jr., as well as a selection of domestic acts.
The event will take place at Naeba Ski Resort in Niigata Prefecture from July 29 to 31. Tickets are now on sale.
First held in 1997, Fuji Rock is one of the longest-running and most anticipated annual music events in the country, and the lineup for its 2022 edition signals that Japan’ s live music industry is attempting to return to normal after many events were canceled, scaled down or dramatically altered due to the pandemic. The Summer Sonic festival in Chiba and Osaka will return in August, while Rock In Japan festival is set to take place at a new location in Chiba after being canceled the past two years.
Smash says they will continue to implement measures to prevent the spread of COVID-19. Festival-goers must register on a smartphone app to attend and those with fevers of 37.5 degrees Celsius or higher will not be permitted. Attendees will also be required to wear masks and undergo temperature checks, and encouraged to keep their distance from others and refrain from shouting.
“ While the end of COVID-19 is not in sight just yet, all of the festival staff will work to prepare for a festival with the theme of ‘ Music with Nature, and living with Corona, ” an introductory message on the official Fuji Rock website reads.
Tickets for this year’ s festival are on sale now. For more information, visit en.fujirockfestival.com. | tech |
Global Aramid Fiber Market was valued at USD 4.11 billion | Pune, India, April 01, 2022 ( GLOBE NEWSWIRE) -- The market has been studied for the below mentioned-segmentation and regional analysis for North America, Europe, Asia, South America, and Middle East and Africa. These are the key regions where the aramid fiber market is operating currently and is predicted to expand in the near future. The manufacturers and suppliers involved in the aramid fiber market is present across various countries in the above-mentioned regions.
The report provides detailed understanding of the market segments which have been formed by combining different prospects such as the product category, application, technology, end-users and others. Apart from this, the key driving factors, restraints, potential growth opportunities and market challenges are also discussed in the below paragraphs.
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Global Aramid Fiber Market Size by Type ( Meta Aramid, Para Aramid and Copolyamide), Application ( Friction Materials, Industrial Filtration, Security and Protection, Rubber Reinforcement, Optical Fibers, Tire Reinforcement, Electrical Insulation and Others), End-user ( Aerospace, Automotive, Electronics and Telecommunication, Industrial and Others), Distribution Channel ( Online and Offline) Regions, Segmentation, and forecast till 2028.
The significant players operating in the global aramid fiber market are Teijin Ltd., DuPont De Numerous Inc., Hyosung Corporation, Kolon Industries, Kermel, SRO Aramid Co. Ltd., Yantai Tayho Advanced Materials Co. Ltd., Toray Industries, Huvis Corporation, China National Bluestar, X-FIPER New Material Co. Ltd. and Toyobo Co. Ltd. and others. To achieve a substantial market share in the worldwide aramid fiber market and strengthen their position, manufacturers are pursuing expansion methods such as current developments, mergers and acquisitions, product innovations, collaborations, and partnerships, joint ventures. Among these, Toray Industries and Teijin Ltd. are one of the most significant manufacturers and distributors present in the global aramid fiber market.
Aramid fibers are well-known material in the aerospace and automobile industry. The aramid fibers are manufactured using long chain synthetic polyamide which consists of two aromatic rings. These aromatic rings are directly attached with the amide linkages. The commercialization of aramid dates back to 1960. These fibers came in limelight due to their exceptional properties, which suited many applications in various industry verticals. Aramid fibers have monomers which consist of teraphthaloyl chloride and 1,4-phenyl-diamine. These materials are yellowish in colour and are light weight. Aramid fibers are known by different trade names all over the world, however, they are identified by their superior properties.
The increasing demand for lightweight, high tensile strength, resistant and durable raw material in applications such as automobile, aerospace and defense, etc. is one of the most promising drivers of the aramid fiber market. Both, aerospace and automobile industries are inclined towards the adoption of materials which are suitable for the construction of the components. Further, the use of such fibers is also required in defense applications, as it is cut resistant, flame resistant and consists of high strength to weight ratio.
The developing regions are adopting the low wight materials for use in different end-users. The regional government has imposed strict regulations for reduction in greenhouse gas emissions especially the vehicle emissions. The use of aramid fiber has thus gained popularity among the countries present in both developed and developing regions. Also, the uprise trend of automotive and transportation industry, is providing lucrative opportunities to the aramid fibers market. The commercialization of newly launched aramid fibers portfolio is attracting many end-user industries. However, the fluctuating in prices of raw materials is a major restraint to the market. Further, various issues regarding the manufacturing cost and increasing use of different alternative fiber is a challenge for the market growth.
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Meta aramid segment is expected to be the fastest growing segment in 2021.
The type segment includes meta aramid, para aramid and copolyamide. Among these, meta aramid is expected to be the fastest growing type segment. Meta aramid fibers are manufactured by wet spinning technology in which the fiber is spined inside a chemical solution. This process provides with a semi-crystalline product which can be used in safety and protection applications. This particular type of aramid fiber has the tendency to withstand extreme stress even in harsh conditions. It can sustain in temperatures ranging upto 400 degree Celsius. Thus, it is the most suitable type of aramid fiber to be used in applications which deals with high temperatures.
Frictional materials segment is expected to be the fastest growing segment in 2021.
The application segment includes friction materials, industrial filtration, security and protection, rubber reinforcement, optical fibers, tire reinforcement, electrical insulation and others. Among these, friction material is expected to be the fastest growing application segment. Aramid fibers have gained tremendous popularity as a friction material especially for automotive components. It is widely used as a replacement for conventional materials in such applications. As aramid fiber can withstand high temperatures, the manufacturers present in automobile industry is opting it to be used in components that are responsible for friction creation.
Automotive segment is expected to be the fastest growing segment in 2021.
The end-user segment includes aerospace, automotive, electronics and telecommunication, industrial and others. Out of the end-users, automotive is expected to be the most lucratively growing segment. Automotive manufacturers are required to adhere to the vehicle emissions imposed by the regional and global agencies. Aramid fibers have been found to increase the fuel efficiency of the passenger and commercial cars. Further, their superior resistant properties against chemical and especially thermal degradation, are the primary reasons for their adoption in automobile industry.
The offline segment led the aramid fiber market with a market share of around 78.43% in 2021.
The distribution channel segment includes online and offline. The offline segment is the dominant distribution channel segment. Offline distribution channel includes retail shops, specialized shops and hardware stores. The aramid fiber market operates in a B2B setting. Thus, the end-users mostly buy in large quantities for the manufacturing of different products.
The regional analysis provides a detailed perception about the key regions and the countries. Some of the key countries analyzed for the aramid fiber include US, Canada, Mexico, Germany, France, U.K., Italy, Spain, Russia, China, Japan India, Brazil, Peru, UAE, South Africa and Saudi Arabia.
Europe region dominated the aramid fiber market and held the 37.09% share of the market revenue in 2021. The growth of the market in the region can be attributed to various factors, such as presence of many global and regional manufacturers, availability of the required technology and abundance of raw materials. The higher pace of defense spending has brought tremendous growth in the regional aramid fiber market. However, North America is projected to register higher growth rate during the forecast period of 2022-2028. The rising investment in automobile industry along with technological developments is the significant factor behind the growing market.
Covid-19 had a major impact on almost all of the industries such as construction, manufacturing, oil and gas, automobile, etc. The demand for aramid fiber has decreased during the period owing to the regulations on social distancing and increasing focus on safety and hygiene. In most of the regions, the manufacturing facilities of aramid fiber were closed in the second and third quarters of fiscal year 2020. The major end-users were also temporarily closed during this period and thus the demand for aramid fiber significantly decreased.
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Japan's new car sales slip to second lowest total on record as production slows | New car sales in Japan declined for the third straight year in fiscal 2021, down 9.5% from a year earlier, as production slowed on shortages of semiconductors and other components amid the coronavirus pandemic, industry bodies said Friday.
A total of 4,215,826 cars were sold in the year ended Thursday, according to the Japan Automobile Dealers Association and the Japan Light Motor Vehicle and Motorcycle Association.
Domestic auto sales excluding mini vehicles slumped 8.2% to 2,660,855 units, the second lowest since the survey began in fiscal 1968.
Toyota Motor Corp. sold 1,313,913 units, down 9.7%. The pandemic’ s impact in Southeast Asia forced it to scramble for parts and temporarily reduce domestic production significantly.
Honda Motor Co. and Nissan Motor Co. marked declines of 3.4% and 1.1%, respectively. Mazda Motor Corp. reported a 15.4% fall, with Subaru Corp. losing 14.2%.
Sales of minivehicles, which have an engine displacement of up to 660cc, tumbled 11.5% to 1,554,971 units, the lowest in 24 years.
Daihatsu Motor Co., Toyota’ s minicar subsidiary, sold 506,436 cars, down 7.8%. Suzuki Motor Corp. suffered a 12.8% fall to 470,498 units. | tech |
Grammys are anyone's game as music's A-listers descend on Vegas | Las Vegas – The top names in music will gather Sunday to honor their own at the Grammys, now in its 64th edition, with pop juggernauts joining jazzman Jon Batiste as the leading nominees.
This year, the gala will take place in Las Vegas for the first time, after organizers postponed the original Jan. 31 event over a surge in COVID-19 cases, and then moved it from Los Angeles to the gambling capital of the United States.
The field is wide open — especially after the Recording Academy expanded the top four categories yet again, this time to include 10 nominees, in a bid to improve diversity.
The timing of the Grammys just one week after Will Smith stunned the world by slapping Chris Rock on stage at the Oscars adds an extra layer of unpredictability to what is already usually one of the more bizarre nights on the showbiz awards circuit.
Justin Bieber will vie for eight trophies at the ceremony hosted by late night host Trevor Noah, as will R & B favorite H.E.R. and singer-rapper Doja Cat.
Grammys darling Billie Eilish is in the running for seven prizes. The same holds true for Olivia Rodrigo, a former Disney channel actress who exploded onto the pop scene last year with her breakout smash hit “ drivers license. ”
The 19-year-old Rodrigo landed expected nods for her much-touted debut album “ Sour, ” and is a near shoo-in for Best New Artist — she is up against Eilish’ s brother Finneas, rapper Saweetie, experimental pop act Japanese Breakfast and others.
Like Eilish in 2020, Rodrigo has the opportunity to sweep the top four categories, which would make her only the third artist to do so.
But it is Jon Batiste — the jazz and R & B artist and bandleader, who won an Oscar last year for his soundtrack to the Pixar animated movie “ Soul ” — who has the most chances at Grammys gold, snagging 11 nominations including in two top categories.
The longtime musical director of the popular “ The Late Show With Stephen Colbert, ” Batiste in recent years has emerged as a voice of social justice and protest.
The Black artist born into a prominent New Orleans musical dynasty will compete mainly on the strength of his album “ We Are ” and its rousing single “ Freedom. ”
The sleeper nominations leader is also up for awards in fields spanning genre and medium, including R & B, jazz, American roots and contemporary classical, along with nods for Best Music Video and his composition work on “ Soul. ”
Lady Gaga and Tony Bennett, the beloved 95-year-old crooner, have strong chances to add to their Grammys haul — their album “ Love For Sale ” earned six nominations.
Kanye West scored several nominations for his album “ Donda ” — and will face off with longtime nemesis Taylor Swift in the Album of the Year category, where she has her sole chance at Grammy gold for “ evermore. ”
Swift did not submit “ Fearless ( Taylor’ s Version) ” — her 2021 re-recording of her 2008 album — for Grammy consideration, after winning four awards for the original in 2010.
The rap categories include West along with Nas, J. Cole and Tyler, the Creator — but not Drake, who withdrew his two nominations in December without explanation.
In the past, the Canadian chart-topper had accused the Recording Academy, which he has long sparred with, of pigeonholing his music in the rap categories because he is Black.
Cardi B and Megan Thee Stallion will compete in the Best Rap Performance category, the only field in which the artists behind the smash “ WAP ” are in the running.
Korean pop juggernauts BTS scored one nomination in the pop categories for the huge commercial hit “ Butter ” — less than expected for the massively popular boy band that has struggled to make inroads at the Grammys.
But BTS is slated to perform on the night watched as much for its staging as the actual awards, as will Rodrigo, Eilish, Batiste and H.E.R. along with Lil Nas X.
West, who has five total nominations, had reportedly been removed from the performance lineup over his sometimes troubling behavior, but some sources said he could still join the lineup at the last minute.
The mercurial West has for weeks been airing personal attacks on comedian Pete Davidson, who is dating West’ s ex-wife Kim Kardashian.
The 44-year-old megastar also was barred on Instagram for 24 hours after insulting Grammy host Noah, who had said West was becoming “ more and more belligerent in how he tries to get Kim back. ” | tech |
A Russian Default Would Raise Financial Risks for Developing and Emerging Markets | About the author: Carmen M. Reinhart is senior vice president and chief economist of the World Bank Group.
The global economy is facing a combination of challenges seldom seen before, and Russia’ s war against Ukraine piles a host of new risks onto the pre-existing ones created or exacerbated by a once-in-a-century pandemic. Rising global inflation and an uneven economic recovery from the 2020 crash that widened the gap between rich and poor nations figure prominently in the long list of risks that mark 2022.
The war is already stoking global inflation. Its immediate economic impacts were forcefully felt in commodity markets in a supply shock reminiscent of the 1970s oil shocks—except this time it also involves spiking food prices. We know that the pandemic has seriously impaired global supply chains and led to soaring transport costs. Government and central bank intervention supported aggregate demand but did little to repair aggregate supply. This imbalance added to costs and set the stage for the return of global inflation. Disruptions from the war have further damaged trade links and stalled the agricultural production of two key global providers. This will fall hardest on developing countries and the poor, who will see much higher prices for food and other basic goods. However, the war’ s adverse effects on advanced economies in Europe should not be underestimated, either.
Added to this pre-existing problem is a new one—the potential fallout in financial markets from a likely default by Russia at some point. Here, the more recent past does not necessarily provide a good road map, as the collapse of Lehman Brothers and the implosion of the housing market in 2008 were very much about advanced economies. This time, many emerging markets and developing countries are likely to be the most affected. Often, those impacts are underestimated because they occur in countries that are off the radar screen and not deemed as systematically important. They are the antithesis to too big to fail.
As for the first challenge, prior to the war, inflation was already proving to be much higher, more persistent, and broader-based than major central banks initially thought possible. In more than half of advanced economies, 12-month inflation through February 2022 was running above 5%. Over 70% of emerging markets and developing economies saw inflation at that level or above, more than double the share prior to the Covid-19 outbreak.
Food inflation is running particularly hot. The risks of a re-emergence of food crises in many parts of the globe and attendant social unrest loom large and should not be underestimated. About 80% of emerging market economies saw food price inflation over 5% in the year leading up to the war. Furthermore, the impacts of the war are likely to be persistent, as the ongoing conflict will continue to interrupt cycles of planting, production, and transport of food, making a bad situation worse. Inflation is a very regressive tax, and food inflation even more so. In lower-income countries, as in poorer households within countries, food and energy spending accounts for a much larger share of expenditure, and higher prices eat up a much larger share of their income. In many developing countries, government finances are poised to deteriorate as the pressure for higher food and fuel subsidies intensifies.
On the second challenge, the possibility that Russia will default on its sovereign external debt due to sanctions, the risks may be clustered on what we don’ t see and can’ t quantify. While markets are focused on the sovereign, Russian corporates also face the prospect of default. So far, financial spillovers have been limited, but it is premature to declare victory on that front. According to the Bank for International Settlements, European banks have limited exposure to Russia, but the extent of nonbank exposure is far more difficult to ascertain. Nonbank interlinkages are often revealed only at the time of default. The market volatility that ensued from the Russian default in the summer of 1998 took down the U.S. hedge fund Long-Term Capital Management and prompted the Federal Reserve to intervene to calm international capital markets.
The financial consequences of a Russian default may also fall disproportionately on emerging markets and developing countries, where economic recovery from the pandemic has been mostly disappointing. Many have simply not recovered yet. Developing countries were already finding it harder and harder to pay their debts. Almost 60% of the world’ s poorest countries eligible for the Debt Service Suspension Initiative that ended last year are either in, or at high risk for, debt distress. More risk-averse investors and rising international interest rates will make it more costly to attract new financing and service existing debt. According to the World Bank’ s International Debt Statistics, total external debt servicing relative to exports roughly doubled from 2010 to 2020. And this was during a period of exceptionally low international interest rates.
A developing-country crisis is not inevitable, but the risks are stacked. It is never a good time for war, but this one comes at a time with some glaring fault lines in the global economy. | business |
Design Group – Strong through the pandemic | Whether it’ s Christmas cards, decorative candles or wall decorations - when it comes to artistically designed gifts or their packaging, it’ s hard for customers in the USA, Europe or Australia to avoid products of the Design Group.
In 2018, the company decided to implement a supply chain management software to bring transparency to its supply chain. Choosing from several companies, the choice fell on OSCA from software specialist Setlog.
This way, the company was well prepared when the pandemic hit. In fact, the consumer goods manufacturer managed the Covid-19 crisis really well and was able to adapt fast and easy.
This was mainly due to flexible partners, a fast IT department and the advantages of Setlog’ s software OSCA. As John Yablonski, Enterprise Applications Director at Design Group, says: `` OSCA enables us to always have visibility into inventory, deadlines and cash flow. ''
The right SCM software not only digitizes processes but also provides an essential competitive advantage. Be prepared for everything in your supply chain!
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32 Cropped Afro Hairstyles Inspired By Street Style And The Fall Runways | This is Texture Talk, a column that deep dives into the dynamic world of curly hair, from crowns of curls that are free flowing to strands that are tucked away in a protective style.
For the past six years, a big, glorious afro had been my signature hairstyle. It really felt like a statement-making reclamation of my Black pride and beauty after years of listening to narrow and toxic beauty ideals and applying chemical relaxer to help permanently straighten my coils as a direct result. And while much of the world was in a holding pattern for the last two years, and stay-at-home COVID orders shuttered beauty salon doors for huge stretches of time, I saw my afro become the true definition of “ larger than life. ” We’ re talking Kaepernick-level. I became a first-time mum during that time, too.
I truly see my type 4 curls as a gift from the hair gods, but I won’ t lie: sporting a healthy and well-kept large afro makes you work for it in terms of a haircare routine. And as I embraced the most demanding, exhausting, exhilarating and rewarding chapter of my life ( a big shout-out to all the fellow mamas out there), I found my regular hair routine becoming harder and harder to accomplish. My long curls looked like a disheveled mess most days and a pineapple puff updo quickly became my hair’ s best friend.
Between juggling the demands of a family, home and career, I recently decided that I desperately needed a hair change-up that better suited my new busy lifestyle: something quick and low-maintenance that still made a strong statement with my natural texture. Cue the cropped afro.
Whether you’ re transitioning away from protective styles, growing out hair that’ s had a little too much chemical processing, or are simply ready for a big chop like myself, a short afro hairstyle has so many eye-catching possibilities ( not to mention looks bomb with a pair of statement earrings!). From the archetypal afro cut — a mini version of the iconic seventies style — to a modern take on the high top, we’ ve rounded up 32 cropped afro hairstyles spotted on the Fall 2022 runways and big-city streets to inspire your next trip to the salon. Click on, friends, click on.
2022 St. Joseph Media All Rights Reserved | general |
'Slow-balization ': How war and the pandemic are reshaping global trade | BRUSSELS – Raising the drawbridge has been a response to war and pestilence throughout human history, and the tumultuous winter of 2022 has similarly led trading nations to turn inward — though talk that the era of globalization may be winding down seems premature.
The damage to international commerce stemming from Russia’ s invasion of Ukraine and the still unvanquished COVID-19 pandemic has made governments and companies more aware they need more resilient supply chains — even if that costs them more.
And as reliance on the mechanisms that drive the world economy gets called into question amid a scramble for resources, prominent voices — including asset management giant Blackrock’ s head Larry Fink — have warned of an end to globalization.
The World Trade Organization, meanwhile, senses at least a slowdown.
It is likely in coming weeks to halve its current 4.7% forecast for global trade growth this year, a Geneva trade official said.
For its Director-General Ngozi Okonjo-Iweala, the best remedy for the twin shocks of war and COVID-19 is to double down on trade.
“ This is not the time to retreat inward, ” she told WTO members this week. “ This is the time to stress the importance of multilateralism, global solidarity and cooperation. ”
She said supply resilience was best served by a deeper and more diverse international market, rather than by concentrating sourcing and production at home, which brought its own risks.
Russia’ s invasion of Ukraine and western sanctions imposed on Moscow have already led to national curbs on food supplies as grain exports from the region dwindle.
The Global Trade Alert database of government policies on international commerce says this year has witnessed the most policy changes hitting essential goods since the outbreak of COVID-19, when medical supplies were limited, with 18 countries setting up export controls on food and fertilizers.
It says 49 controls have been put in place on the two products, 31 of them in the month since Russia’ s invasion of Ukraine, with only two since removed.
Longer term, policymakers are waiting on China, which could fragment the world economy by choosing to align itself closely with Russia.
Addressing that concern, Bank of England Gov. Andrew Bailey said the situation, along with sharp commodity price swings, was even more challenging than the aftermath of the global financial crisis of 2007 to 2009.
“ I think it is important that … we make clear that we are not abandoning our commitment to an open world economy, ” he told an event Monday.
China has opposed the sanctions against Russia and said it will maintain normal economic relations with Moscow.
Their bilateral trade has surged, although those figures are dwarfed by Chinese trade with the rest of the world.
Analysts say China could offset some of its neighbor’ s pain by buying more from Russia, but it would be wary of falling foul of sanctions itself. Behind the scenes, Beijing is pressing companies to tread carefully with investments in Russia.
Still, Wang Yiwei, director of the Institute of International Affairs at Beijing’ s Renmin University, said the Ukraine crisis had exposed Europe’ s reliance on Russian energy and would increase its concern about dependence on China.
“ The Ukraine-Russia conflict has highlighted the risks of globalization and accelerated a trend of deglobalization, ” he said.
The world economy was moving more towards regionalization, he said, citing the 15-member Regional Comprehensive Economic Partnership trade pact as an example.
In his letter to shareholders a week ago, Blackrock’ s Fink was more blunt, declaring an end to three decades of globalization. Companies were reanalyzing their manufacturing footprints, something that COVID-19 had already spurred them to do.
“ And while dependence on Russian energy is in the spotlight, companies and governments will also be looking more broadly at their dependencies on other nations, ” Fink said.
Patrick Harker, the president of the Federal Reserve Bank of Philadelphia, said constant waves of COVID-19 hitting supply chains had prompted a concerted effort to build a more resilient network, but this insurance would come at a cost.
As a reminder that the pandemic is not over, China’ s “ COVID zero ” approach has left Shanghai, the country’ s most populous city and the world’ s largest container port, in lockdown.
Former WTO chief Pascal Lamy said that, rather than deglobalization, the world seemed set for a period of “ slow-balization. ”
Services trade in particular should keep transfers across national borders growing, but there was likely to be some reshoring of goods, albeit limited.
“ COVID and to some extent Ukraine have told us that we have to factor in more risks, ” he said. “ Offshoring happened because it was more efficient. Reshoring happens because fragilities that were not priced in have appeared. … It is limited by the fact that it is costly and that consumers will have to pay this extra price. ” | tech |
Attorney General Bonta Issues Warning to Eviction Lawyers After Receiving Reports That Landlords May Be Filing False Declarations to Evict California Families - The Santa Barbara Independent |
Press releases are posted on Independent.com as a free community service.
OAKLAND — California Attorney General Rob Bonta today announced that he sent warning letters to 91 law firms across the state that represent landlords in eviction cases after being notified that some firms and their clients may have violated the law. The California Department of Justice’ s Housing Strike Force has received reports that landlords, or the attorneys representing them, may be falsely declaring that tenants have not notified them of a pending emergency rental assistance application in order to push through evictions. COVID-19 emergency tenant protections prohibit landlords from moving forward with eviction proceedings while a tenant’ s rental assistance application is pending.
“ We have reason to believe that some landlords and their attorneys may be filing false declarations to push hardworking Californians out of their homes, ” said Attorney General Bonta. “ This is unacceptable, and more importantly, absolutely illegal. California families were already struggling with the high cost of housing before the pandemic, and these past two years have only made things worse. Our Housing Strike Force is investigating these reports, and if necessary, we will take action. ”
Under the COVID-19 Tenant Relief Act, landlords are not permitted to evict tenants for unpaid rent due to COVID-19 related financial hardship unless ( 1) government rental assistance has been denied or ( 2) the landlord certifies that they completed a rental assistance application, 20 days have passed since the application was submitted, and the landlord has not received notice from either the government or the tenant indicating that the tenant has applied for rental assistance. Legislation passed today extends these eviction protections through June for those who have applied for rental assistance by March 31, 2022.
The Housing Strike Force has received reports that some attorneys representing landlords may be filing declarations – or allowing their clients to file declarations — that falsely indicate that the landlord has received no notice that the tenant applied for rental assistance, even when there is clear evidence to the contrary. Likewise, it appears that some attorneys are continuing to prosecute existing eviction actions after learning that the declaration supporting issuance of a court summons was false. The Housing Strike Force received these reports through ongoing outreach to tenant advocacy organizations, including during a series of roundtables hosted across California earlier this month.
Filing false declarations in court violates multiple state laws, as does continuing to prosecute a case after learning that the declaration used to initiate it is false. In the letter, Attorney General Bonta strongly encourages law firms to review the eviction cases they have on file or plan to file to ensure compliance with the law. The Housing Strike Force encourages Californians to send complaints or tips related to housing to housing @ doj.ca.gov.
If you are a tenant struggling to pay rent due to COVID-19 related financial hardship, apply for rental assistance today. The deadline to apply is today. Income eligibility limits apply. You must take action to get this assistance.
If you have submitted a rental assistance application, notify your landlord in writing immediately. Save a copy of the email, text, or letter that you send. If you are sued or receive an eviction notice, don’ t ignore it – get help. Information on legal aid in your area is available at lawhelpca.org.
Attorney General Bonta is committed to addressing the state’ s housing shortage and affordability crisis and alleviating its effects on California families. In November, Attorney General Bonta announced the creation of a Housing Strike Force within the California Department of Justice and launched a Housing Portal on DOJ’ s website with resources and information for California homeowners and tenants. The Housing Strike Force is actively monitoring compliance with state housing laws, and recently sent letters notifying Woodside and Pasadena of violation of SB 9 and Encinitas of violations of state housing laws relating to its rejection of a proposed mixed use development project. Last year, the Housing Strike Force secured a $ 3.5 million judgment against Wedgewood that resolved allegations that the company was unlawfully evicting tenants from properties purchased at foreclosure sales.
A copy of the letter can be found here. | general |
Safety risks hit home for employers | BI’ s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.
To search specifically for more than one word, put the search term in quotation marks. For example, “ workers compensation ”. This will limit your search to that combination of words.
To search for a combination of terms, use quotations and the & symbol. For example, “ hurricane ” & “ loss ”.
Remote and hybrid work arrangements, which were put in place when pandemic lockdowns forced many workers to stay home, have left employers with lingering safety-related concerns even as COVID-19 fades.
Many ergonomics concerns related to remote work were well-known before the pandemic, but with home offices commonplace those issues demand an extra level of attention, sources say. And employers should be particularly careful about workers compensation exposures that have evolved as employees continue to operate from remote locations.
Employers can use technology to help set employees up remotely and train them on safety protocols, they say.
A workers comp claim filed in a state where an employee didn’ t previously work could create problems if the employer did not update its records and filings, said Peter R. Siegel, an attorney in the labor and employment and litigation practice groups at Greenspoon Marder LLP in Fort Lauderdale, Florida.
“ The employer could become liable not only for the claim and medical bills and lost income but could also be subject to penalties and fines in the state in which the claim was filed, ” Mr. Siegel said. “ We tell companies all the time, you need to do a better job of tracking your employees. ”
“ Employers are, unfortunately, failing to have workers comp policies that accurately reflect their workforce, ” he said. Many assumed the pandemic would be over quickly and “ are still operating under an obsolete policy, meaning that nowhere in the policy does it contemplate the reality of having employees throughout the United States. ”
The fix usually requires an investment of time to sort out coverage.
“ Employers need to get with their broker and insurance carrier and make sure that their workers comp policy reflects this new reality of remote work, ” Mr. Siegel said.
Some employers obtain “ all-states policies ” that give them flexibility if they have a multi-state workforce, while others buy a separate policy for remote workers, he said.
Insurers may provide a policy that allows employers to list the residences and working locations of all employees.
“ One of the key issues in managing this type of risk is determining compensability, ” said Rich Ives, vice president responsible for workers comp claims at Travelers Cos. Inc. in Hartford, Connecticut. That means sorting out whether an injury occurred in the course and scope of employment, he said.
Insurers will also want to know whether an injury was related to a pre-existing condition, Mr. Ives said. That’ s the aim of a Travelers unit that investigates claimants’ medical histories to determine whether a condition existed prior to working remotely, he said.
Polly James, senior director of risk management at Feld Entertainment Inc. in Palmetto, Florida, who also worked in risk management for a major hotel company, said most employees wouldn’ t try to hoodwink employers. “ Most people who have an accident at home are more likely to take responsibility for it themselves and not submit a workers comp claim, ” she said.
That appears to be true for Lockton Cos. LLC, said Paul Primavera, the broker’ s executive vice president and national risk control services practice leader in Irvine, California. The burden is on the remote worker to prove whether injuries are work-related, and the broker has not seen a noticeable difference in claims as workers have moved their offices to their homes, he said.
But employers do increase the odds of workers comp claims if they ignore employees’ home-office ergonomics, experts say.
“ The amount of time they are spending on their computers is skyrocketing, and the potential for ergonomic-related workers comp claims can increase with remote workers, ” said Liz Petersen, San Diego-based quality manager in the Society for Human Resource Management’ s knowledge center.
“ Many people who started working from a virtual office two years ago might still be sitting in the same chair in their kitchen and working off the same table, ” said Chris Hayes, Hartford-based assistant vice president in risk control for workers compensation and transportation at Travelers.
“ If you have someone working from home for any period of time, you need to make sure they have a good ergonomic setup ” that includes a chair that supports appropriate posture as well as proper monitor height, keyboard reach, mouse position and other features, he said.
Alan Roberts, senior risk engineering consultant with Zurich Resilience Solutions in San Francisco, a unit of Zurich Insurance Group Ltd., said many companies use self-assessment software to identify and manage ergonomic risk factors when workers report problems.
Employers should stress the importance of early reporting of discomfort, Mr. Roberts said. Knowing as soon as possible what’ s troubling workers can reveal the kinds of changes that need to be made and get them healthy quicker, he said.
Ideally, ergonomics training should take place before a worker moves to a remote location, according to Mr. Roberts and other experts.
Close attention to ergonomics has apparently paid off for employers, said Jennifer Law, vice president, senior loss control consultant, with Lockton Cos. LLC in Charlotte, North Carolina. “ We see the risk, ” she said, but have not seen an increase in workers comp claims.
Ms. Law said employers were forced by pandemic lockdowns to advise workers on setting up remote offices and to supply them with furniture and equipment designed to keep them safe. Many consult virtually with employees to determine their office needs and contract with third-party vendors to help set up the workspaces, she said.
1. FM Global, Allianz receive poor grades for Russia response
2. Lockton recruits cyber leader from AIG
3. Axa XL names former Marsh exec to senior underwriter post
4. Zurich North America announces promotions
5. AIG, Chubb off hook for McKesson opioid defense costs
6. Alliant names Arkley president of retail property/casualty | general |
Data Ingestion with Pandas: A Beginner Tutorial | Learn tricks on importing various data formats using Pandas with a few lines of code. We will be learning to import SQL databases, Excel sheets, HTML tables, CSV, and JSON files with examples.
Pandas is easy to use, open-source data analysis tool which is widely used by data analytics, data engineering, data science, and machine learning engineers. It comes with powerful functions such as data cleaning & manipulations, supporting popular data formats, and data visualization using matplotlib. Most data science students only learn to import CSV, but at work, you have to deal with multiple data formats, and things can get complicated if you are doing it for the first time. In this guide, we will be focusing on importing CSV, Excel, SQL, HTML, and JSON datasets.
For running SQL queries, we need to download SQLite database for Kaggle Mental Health in the Tech Industry under the License CC BY-SA 4.0. The database contains three tables; Questions, Answer, and Survey.
To import data from any SQL server, we need to create a connection ( SQLAlchemy connectable / sqlite3), write SQL query, and use Pandas’ s read sql query () function to convert output to dataframe. In our case, we will first connect mental health.sqlite by using sqlite3 package and then pass the object into the read sql query () function. The last step is to write a query to import all columns from the Question table. If you are new to SQL, I will suggest you learn the basics by taking a free course: Learn SQL | Codecademy.
We have successfully converted SQL query into Pandas dataframe. It’ s that easy.
Web scraping is a complicated and time-consuming job in the tech world. You will be using Beautiful Soup, Selenium, and Scrapy to extract and clean your HTML data. Using Pandas read html (), you can skip all the steps and directly import table data from the website into a dataframe. It’ s that easy. In our case, we will be scraping the COVID-19 Vaccination Tracker website to extract tables containing COVID19 vaccination data.
Just by using pd.read html () we were able to extract the data from the website.
Our initial output was list and to convert list into a dataframe we have use [ 0 ] at the end. This will only display the first value in the list.
Note: You need to experiment with your initial result to get the perfect result.
CSV is the most common file format in data science. It is simple and can be accessed by multiple Python packages. The first thing you will learn in a data science course is to import a CSV file. In our case, we are using Kaggle’ s Bike Sharing Dataset under CC0: Public Domain license. The values in CSV are separated by commas as shown below.
We will use the read csv () function to import the dataset into Pandas dataframe. This function is quite powerful as we can parse dates, remove missing values and do a lot of data cleaning with just one line of code.
We have successfully loaded the CSV file and displayed the first five rows.
Excel sheets are still popular among data and business analytics professionals. In our case we will be converting the U.S. Presidents and Debt dataset by kevinnayar under CC BY 2.0 license into.xlsx format by using Microsoft Excel. Our Excel file contains two sheets but Pandas dataframe is a flat table, we will use sheet name to import selected sheets into Pandas dataframe.
Reading JSON files is quite tricky as there are multiple formats that you need to understand. Sometimes, Pandas fails to import nested JSON files so we need to perform manual steps to import the file perfectly. JSON is the most common file format for the tech industry. It is preferred by web developers to data engineers. In our case, we are going to download the Spotify Recommendation dataset under CC0: Public Domain license. The dataset contains good songs and bad songs JSON files. For this example, we will only use the good.json file. As we can observe, we are dealing with a nested dataset.
Before doing any data processing let’ s import the dataset without parameters by using the read json () function.
As we can observe, the dataframe contains only one column, and it's all over the place. To debug this issue, we need to import the raw dataset and then parse it.
First, we will be importing raw JSON files using the json package and only selecting the audio features subset. Finally, we will convert the JSON to Pandas dataframe by using the json normalize () function.
It’ s a success and we have finally parsed the JSON into a dataframe. If you are dealing with a multi-layer nested JSON file, try to import the raw data and then process the data so that the final output is a flat table.
The code and all datasets are available at Deepnote. | tech |
Yales ' PHATE Data Analysis Algorithm Predicts Mortality Rates Among COVID-19 Patients | Yale researchers have announced their PHATE algorithm for data analysis can be used to detect COVID-19 among patients and indicate risks of mortality in infected patients.
The COVID-19 pandemic has inflicted permanent damage to the human race, killing millions and impairing the immunity of billions of humans. Kids as young as six months old are getting tested positive for COVID-19. In such desperate times where healthcare authorities are focusing on minimizing the rate of infection and bringing down the number of deaths, Artificial intelligence and deep learning tools could come to their rescue. In a recent update on the use of data analysis tools for healthcare and pharmacology, Yale researchers announced their recent invention.
Yale revealed the scope of its multiscale PHATE algorithm last month in the journal of Nature Biotechnology. This Machine Learning tool for data analysis allows researchers to scan through millions of granular level data of millions of cells and zero onto a single infected cell within minutes. Developed in the lab of Dr. Smita Krishnaswamy, who is an Associate Professor of Genetics and Computer Science, PHATE machine learning algorithm for data analysis snips through the conventional challenges faced in data visualization of Big Data projects. PHATE’ s machine learning algorithm is so precise that it can “ zoom in and focus on specific subsets of data to perform detailed analysis, ” said Manik Kuchroo, a doctoral candidate at Yale School of Medicine.
During the development of this ML-based data analysis tool for COVID-19, researchers at Yale found TH17 helper T-cell influenced the outcome of the infection. By measuring these TH17 cells clustered with the immune system cell IL-17 and IFNG, Yale researchers could find out if the infected person survived or died with an 83% precision. PHATE plot of immune cells clusters provides predictive modeling and analysis of COVID-19 mortality rates. Yale researchers would continue to fine-tune the assessment from the PHATE Machine Learning tool for other infections diseases as well.
Recommended: Conversational AI SaaS Marketing By 2025, Chatbot Messaging App Accesses to Reach 9.5 Billion Globally | tech |
Japan to ease border controls to allow entry for up to 10,000 nontourists per day | Japan will raise its daily limit on arrivals from overseas to around 10,000 from April 10, up from the current 7,000, the top government spokesman said Friday, as the country gradually relaxes its coronavirus border controls.
The easing of the nation’ s strict border controls is in response to growing demand for entry among returning Japanese nationals, foreign residents and new nontourist arrivals, including foreign students, Chief Cabinet Secretary Hirokazu Matsuno said. Foreign tourists are still barred from entry.
“ Japan plans to increase international movements of people in stages by taking into account the infection situation at home and abroad and border control measures that other major nations have taken, ” Matsuno said at a news conference.
Japan effectively imposed an entry ban on nonresident foreign nationals in late November to limit the inflow of the highly transmissible Omicron variant, drawing criticism from students, academics and business circles that the measure was too strict.
In recent weeks, the country has been relaxing what Prime Minister Fumio Kisida called the “ most stringent ” border controls among the Group of Seven nations. The daily entry limit was raised by 2,000 to the current 7,000 in mid-March, ahead of the start of the new Japanese school and business year in April.
COVID-19 travel restrictions have prevented foreign students from traveling to Japan, with around 150,000 said to be waiting as of March 1. So far, over 10,000 of them have arrived in Japan, Matsuno said.
The government has prioritized foreign students by allocating empty seats on weekday flights to facilitate their entry into Japan.
Also on Friday, Japan eased its coronavirus travel warning for 106 nations, including the United States and India, and is no longer recommending that Japanese nationals avoid traveling to these areas.
The Foreign Ministry lowered its travel advisories to Level 2 for those countries, also including Britain, France and Germany, from the second-highest Level 3.
Level 2 means that Japanese citizens are asked to refrain from nonessential travel to the countries, while Level 3 means that people should avoid all travel to the affected areas.
Meanwhile, 56 nations and regions remained under the Level 3 warning, including 40 in the Middle East and Africa, 10 in Europe and six in Latin America.
“ Although the situations are different among nations and areas, the number of new COVID-19 infections and deaths has been on a decreasing trend globally, and risks of dying and developing serious symptoms have been reduced on the back of progress in vaccinations, ” Foreign Minister Yoshimasa Hayashi said at a news conference.
Hayashi also cited gradual easing of restrictions on economic activities and traveling overseas in many countries.
The ministry left unchanged Level 2 advisories for 39 nations and regions. Among them are China, South Korea, Taiwan and Australia, for which the warning was lowered from Level 3 to Level 2 in October 2020. | tech |
US companies further trim pandemic-era cash buffers | U.S. nonfinancial corporate cash ratios ticked down further in the fourth quarter of 2021 as companies continued to draw down on the cash buffers built up in response to COVID-19.
The median cash ratio of companies rated investment grade by S & P Global Ratings — calculated by comparing a company's cash and cash equivalents to its current liabilities — fell to 24.5% in the fourth quarter of 2021. This was down from 26.9% in the previous quarter and the lowest rate since the fourth quarter of 2019, the latest S & P Global Market Intelligence data showed.
It was a similar story for lower-rated companies. The median cash ratio for corporations rated non-investment grade fell to 37.9% in the fourth quarter of 2021, down from 43.1% the previous quarter and 49.8% a year earlier.
The COVID-19 pandemic shocked financial markets in March 2020 as the healthcare crisis seemed poised to morph into an economic crisis. U.S. companies faced collapsing revenues and spiking borrowing costs. The Federal Reserve's decision to restart its quantitative easing program encouraged investors to return to the market, providing ample liquidity and increasingly cheap credit for companies.
Companies promptly borrowed heavily, shattering bond issuance records and staving off the spike in defaults that had been anticipated. A prompt recovery in the economy supported earnings and companies found themselves with significantly higher liquidity buffers than they had previously.
These cash ratios have been gradually wound down since the peak in the second quarter of 2020, though they remain significantly higher than the pre-pandemic levels.
Some sectors are further down the road of normalization than others. The median ratio for investment-grade utilities was 3.7% in the fourth quarter, as opposed to a pre-pandemic level of 3.1%. For non-investment-grade utilities, the median ratio was lower than the pre-pandemic level at 11.3% compared to 12.9%.
The materials, industrials and financials sectors have also largely normalized their cash ratios.
Other sectors are retaining higher liquidity buffers, most notably information technology and real estate. In the case of the former, liquidity buffers were typically high pre-pandemic because IT companies typically generate high cash amounts. | business |
Visa cardholders score discounts on Covid-19 testing | The partnership will also allow cardholders to book a Covid-19 test ( through the Collinson website), at their preferred ‘ in-city’ clinic from a selection of testing facilities. Launched on the 25th of March, the partnership will extend benefits to Visa cardholders in Singapore, the UK and a number of APAC markets. Launched under the banner of allowing a ‘ seamless and secure Covid-19 testing process for Visa cardholders’, following completion of their test, customers will receive a test certificate with their PCR test results within 36 hours. Results will be received within an hour for rapid antigen tests. Visa cardholders will also be offered discounted pricing as follows: a 15% discount on all PCR tests in Singapore a 10% discount on all PCR tests in the rest of Asia Pacific markets a 5% discount on antigen tests in Asia Pacific, and a 20% discount for any type of test taken within the UK. On the announcement, Conor Lynch, head of Consumer Solutions, Asia Pacific, Visa, stated: “ With a Visa card, travellers can access a range of benefits, which now includes discounts on pre-departure travel tests; especially important today as the world adapts to new norms of travel. Together with Collinson, Visa is keen to make it convenient and hassle-free for travellers to take to the skies again. ” Todd Handcock, president, Asia Pacific at Collinson, added: “ While Asia Pacific continues to be the ‘ first in, last out’ of the COVID-19 pandemic, the importance of travel testing remains. We are delighted to be working with Visa to help the safe restart of global travel, and with more destinations opening up to travellers once again, we look forward to helping to restore their travel confidence as they take to the skies. ” | tech |
Citi raises its forecast for China's GDP growth | In this article
BEIJING — China's economy faces so much new pressure from Covid that Beijing may increase stimulus — boosting overall growth, Citi said Thursday.
`` Given the strong start of the year and the anticipated government support, we revise up our growth forecast from 4.7% to 5.0% for 2022, '' Xiangrong Yu, chief China economist at Citi, said in a report late Thursday.
The new forecast is closer to the official gross domestic product target of around 5.5%, which was announced in early March. For January and February, China reported better-than-expected growth in retail sales, fixed asset investment and industrial production.
The upgrade to Citi's GDP forecast comes on the back of expectations of investment in projects such as infrastructure and affordable housing, according to the report.
The official Purchasing Managers ' Indexes — which measure market conditions — for manufacturing and services businesses both fell into contraction territory in March. That's the first time both indexes have done so since February 2020.
`` The current Omicron wave is the worst outbreak since Wuhan, but its impact on PMI appears lighter than implied by the severity of the outbreak, '' Yu said Thursday. `` The data shows that the impact of the containment measures is substantial on demand and services but milder on production and construction. ''
`` China [ is ] adapting to minimize the economic costs while implementing the 'dynamic zero-Covid ' policy, '' he said.
In March, China faced its worst wave of Covid-19 since the initial shock of the pandemic in 2020. Major cities like Shanghai and Shenzhen have had to impose lockdowns and quarantines to control outbreaks of the highly transmissible omicron variant.
The Caixin manufacturing PMI, a third-party study that covers more smaller businesses than the official survey, also fell into contraction territory in March and its lowest since February 2020, according to data released Friday.
One of the actions Yu expects policymakers to take is supporting the struggling, massive real estate industry. Beijing can't afford to wait any longer on efforts to stabilize the property market with measures such as looser credit policies, he said.
Housing sales slumped in the last several months as Beijing clamped down on developers ' high reliance on debt for growth. Real estate and related sectors have accounted for at least 25% of China's economy, according to Moody's.
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Yu and other economists also expect the People's Bank of China will this month cut interest rates or the amount of reserves banks need to have on hand.
`` China [ has a ] very ambitious growth target to meet by the end of the year, '' Carlos Casanova, senior Asia economist at UBP, said Thursday on CNBC's `` Capital Connection. ''
`` If they fail to implement another round of rate cuts in April, '' he said, `` unfortunately that is bad news because that 5.5% [ goal then ] would become very difficult to achieve. '' | business |
Insurers settle $ 20.5 million claims related to plane crash | BI’ s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.
To search specifically for more than one word, put the search term in quotation marks. For example, “ workers compensation ”. This will limit your search to that combination of words.
To search for a combination of terms, use quotations and the & symbol. For example, “ hurricane ” & “ loss ”.
The China Banking and Insurance Regulatory Commission said that insurers settled at least 130 million Chinese yuan ( $ 20.5 million) worth of property and personal insurance claims related to the recent China Eastern Airlines Corp. Ltd.’ s aircraft crash, as of March 29, Asia Insurance Review reported. Insurers PICC Property and Casualty Co. Ltd., China Pacific Insurance ( Group) Co. Ltd., Ping An Property & Casualty Insurance Co. of China Ltd. and China Life Property and Casualty Insurance Co. Ltd. have paid an aggregate amount of CNY116 million to China Eastern Airlines under aircraft hull insurance contract so far.
1. Regulator revokes licenses of financially troubled insurers
2. Axa won’ t appeal landmark COVID-19 BI ruling
3. Brokers calls for mandatory insurance for all buildings
4. Hardening market to go on longer than anticipated: Howden
5. Insurers settle $ 20.5 million claims related to plane crash
6. Insurance market hardening slows down, but concerns remain | general |
Singapore reopens borders after two-year Covid closure | Hi, what are you looking for?
Singapore fully reopened its borders to all vaccinated visitors Friday after a two-year coronavirus closure.
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Singapore fully reopened its borders to all vaccinated visitors Friday after a two-year coronavirus closure, with arrivals saying it felt “ wonderful ” to travel again without onerous restrictions.
The aviation hub, a key gateway for people arriving in Asia, joins other countries in the region that have recently dropped travel curbs as they shift to living with Covid-19.
Previously, only travellers from a handful of places could enter Singapore without quarantining but from Friday all vaccinated arrivals just need a negative Covid test.
The city-state’ s Changi Airport buzzed with activity as passengers streamed out of the arrival area, while hundreds were lining up in the departure zone to make trips outside Singapore.
“ It’ s wonderful, ” Aldo Pizzini, a 63-year-old Italian businessman who had flown in from Milan, told AFP.
“ I took the first opportunity to fly today, ( now) that much of the restrictions are lifted… We are coming back to normality. ”
Diana Mathias, who is from French Guiana and lives in Abu Dhabi, was visiting Singapore for a holiday with her mother.
“ I feel really happy because it’ s a long time since I flew, ” she said.
The 38-year-old said she was a “ bit stressed ” at the prospect of doing a lot of paperwork to travel again but in the end found the process “ really easy ”.
Borders also reopened fully in neighbouring Malaysia on Friday, and thousands of cars and motorcycles flooded across a one-kilometre ( 0.6 mile) causeway that separates it from Singapore.
The causeway, one of the world’ s busiest land borders, had already partially reopened last year although some curbs were still in place.
The main airport serving Kuala Lumpur was busy as foreign tourists arrived.
Previously tourists were barred from entering Malaysia, a popular destination due to its white-sand beaches and lush rainforests, but vaccinated travellers can now do so with only a negative Covid test.
Bo Lingam — group CEO of leading regional carrier AirAsia, which is based in Malaysia — predicted a “ surge ” in people flying.
The reopening of borders is “ a joy for me and our AirAsia staff who had to face a lot of hardship during the pandemic ”, he told AFP.
“ From today, it is all about flying the blue skies and an end to our planes sitting on the tarmac. ”
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
A cargo airplane broke up during an emergency landing in Costa Rica on Thursday.
Britain is sending Ukraine more Starstreak anti-aircraft missiles and 800 anti-tank missiles after an attack on a train station.
The Thursday confirmation of Ketanji Brown Jackson to the US Supreme Court marks an undeniable success for Joe Biden.
Scientists have created a data set of synthetic eye movements that can train the machine learning classifier for a new program.
COPYRIGHT © 1998 - 2022 DIGITAL JOURNAL INC. Digital Journal is not responsible for the content of external sites. Read more about our external linking. | general |
Disaster tourism: blackouts, shortages hit Sri Lanka recovery hopes | Hi, what are you looking for?
Worsening fuel shortages are making it harder to move around the country, with long lines of motorbike taxis waiting for scarce petrol.
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In a Sri Lankan beach guesthouse blacked out by a power cut, the owner’ s son illuminates a printed Wifi password with his phone for two European backpackers. A moment later the trio grasp the gesture’ s futility.
Electricity stoppages, petrol queues and escalating protests are threatening hopes that a tourism revival could help arrest the island nation’ s intensifying financial crisis.
After being ravaged by civil war for decades the country’ s coconut palm-lined beaches and exotic wildlife more recently made it a popular stomping ground for both high-end globetrotters and budget travellers.
Tourism became crucial to the economy — its pandemic-enforced closure underlies the foreign exchange shortage that is the root cause of the current situation.
But now the effects of the crisis are putting in jeopardy the industry that is a key element of any possible solution, with many smaller operators expecting to hit the wall soon.
“ Because of the power cuts, we can’ t serve our customers, ” the darkened hostel’ s owner Dilip Sandaruwan told AFP. “ They’ re not satisfied and they’ re asking for lower prices. ”
His guesthouse a short walk from the beach in the languid coastal town of Mirissa has few reservations, and his family are struggling to pay the interest on borrowings taken to weather the Covid years — let alone the principal.
“ We are always tense, ” Sandaruwan said. “ We don’ t know how to pay back our loans, but the banks are putting a lot of pressure on us. ”
Similar tales of woe echo among business owners up and down Mirissa’ s back lanes.
Guests gripe about sweating through tropical nights without air conditioning, hoteliers can not access online booking platforms, and restaurants fret over how to cater to western tastes when they struggle to source imported coffee.
Worsening fuel shortages are making it harder to move around the country, with long lines of motorbike taxis snarled outside service stations waiting for scarce petrol.
“ I never let the foreigners know that there is a problem with the fuel, ” said motorboat tour company owner Pradeep Chandana De Silva.
He sends staff out before dawn each day to hunt for diesel to ferry tourists across the mangrove lagoons of Balapitiya, pointing out cormorants and baby crocodiles along the way.
“ At the moment the situation is okay, but if there’ s longer queues and less fuel, it will be terrible for the entire industry, ” he said.
– ‘ Pretty crazy’ –
Shortages are making daily life miserable for many in Sri Lanka and resentment is flaring, with security forces deployed around Colombo Friday after protesters attempted to storm the president’ s home overnight.
But bewildered foreign adventurers often arrive without knowledge of the crisis, or a grasp of its scale.
“ Everyone here is telling you, ‘ Hey, we have a lot of problems with gas, fuel, electricity and stuff like that’, ” said Nick Reiter, a German tourist waiting to fill up his rented scooter at a petrol station.
“ But right now, this is pretty crazy. ”
Indian tourist Ayesha Khan said she was unaware of the situation until after booking her flights, and considered cancelling.
“ We didn’ t know a lot until we actually came here, ” she said, breaking off a romantic sunset walk along Mirissa beach with her husband.
Both knew their driver had waited for hours in petrol lines and said the electricity in their accommodation had regularly cut out without warning, but neither regretted their trip.
“ It’ s been nothing but a good experience for us, ” said Afnan Syed, Khan’ s partner.
“ I wouldn’ t mind coming here again. ”
– ‘ Not sufficient at all’ –
Sri Lankan tourism has been plagued by setbacks before, even after the civil war. Islamist attacks on Easter Sunday three years ago targeted hotels and churches, killing 279 people and leading to a wave of cancellations.
A post-pandemic recovery began late last year, with nearly 100,000 coming in February, around 40 percent of previous peaks.
But late that month Russia invaded Ukraine, halting nearly all visits from the number one and three sources of foreign arrivals.
And now even a fully thriving tourism industry would not be enough on its own for Sri Lanka to claw itself out from under its escalating loan repayments, experts say.
“ While tourism has picked up since Covid… it’ s not sufficient at all, ” said Suramya Ameresekera, an economist at the JB Securities advisory firm in Colombo.
“ The amount that comes due every month is not covered by the size of the tourism receipts, ” she added. “ Even in Sri Lanka’ s history when tourism was at its peak… we were still running a current account deficit. ”
The government is scrambling to insulate holidaymakers from the hardships facing much of the nation’ s 22 million people. Accredited tour guides are allowed to skip petrol queues — to the occasional chagrin of other drivers waiting in line.
“ We found some problems because they are out of petrol, ” said Spanish tourist Nazareth Marina in Galle’ s centuries-old Dutch Fort.
But the Sri Lankan people, she added, “ treat us really well, so it was really nice to come here now ”.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
That’ s the real danger. Nobody trusts Russian judgment anymore.
The UN refugee agency UNHCR says 4,656,509 Ukrainians have fled since Russia invaded on February 24 - Copyright AFP FARJANA K. GODHULYRobin MILLARDMore than...
President Joe Biden for the first time accused Vladimir Putin's forces of committing genocide in Ukraine.
AI, facial recognition, and biometrics can help the world get back to work.
COPYRIGHT © 1998 - 2022 DIGITAL JOURNAL INC. Digital Journal is not responsible for the content of external sites. Read more about our external linking. | general |
Transgender Day: Absurdity of Ted Cruz's statements couldn't be clearer | Hi, what are you looking for?
In the past year I have been rejected by four doctors to be accepted as a patient based solely on my trans status.
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The last day of March marks ‘ Transgender Day of Visibility’, and event that has been put together my supporters of transgender rights in the U.S.
The aim of the day is to raise awareness, although the path towards full visibility of trans rights remains a work in progress, given that the states of Iowa. Florida. Arizona. Texas. Utah. Tennessee. Missouri have passed or are considering bills that in one way or another target transgender adults and children.
In this context, the comment: “ I’ m a Hispanic man. Could I decide I was an Asian man? ” made by Senator Ted Cruz, during Judge Ketanji Brown Jackson’ s confirmation hearing, seemed to mock trans existence.
All in society, including politicians, need to be mindful about the language they are using, especially where this is deployed to score cheap political points at the expense of trans people. To do so risks belittling the existence of trans people and traumatizing young trans people.
To challenge the misconceptions, and in support of Transgender Day of Visibility, openly transgender business leaders are speaking out, offering visibility and hope for young trans people.
One such leader is Joseph Schneier, CEO of Trusty.care, who features in the The Gaingels 100, which is a collection of accomplished venture-backed, LGBTQIA+ entrepreneurs.
According to Joseph Schneier, in a statement sent to Digital Journal: “ Unlike most people in the world, the absurdity of Sen. Ted Cruz’ statements couldn’ t be clearer to me. ”
Schneier begins by outlining the importance of identity: “ I am a mid-40s, white, VC-backed startup entrepreneur. I am a capitalist, a word that causes my French relatives to shudder. When I speak in a room, people listen. When I walk down the street at night, I am never worried. I live the life of a relatively privileged man where I have the freedom to build companies that help to improve the world, while making my investors’ money. ”
Returning to Cruz: “ So why am I qualified to speak to the absurdity? ”
The reason is outlined: “ As a single woman, I moved to the US with one suitcase and two small children. I built several companies in the first decade of being in the country, and I can say with 100 percent certainty that at every step my life was harder solely due to my gender ”.
There are business challenges too, Schneier points out: “ Raising capital was harder as a woman. Safety, harder. Just being taken seriously was harder. I had to work 10 times as hard as my male peers, and despite being CEO I was often asked if I was the secretary. ”
Continuing this, Schneier expands: “ The idea that someone would transition to being a woman to gain some benefit should be something that even the most conservative man should not be able to say with a straight face. Did I transition to gain power? Of course not, but is it easier to be a man, I am sorry but it just is. Now all that said I do face gender discrimination, but only in places where people know that I am trans. ”
Moving on to other challenges in life, Schneier states: “ In the past year I have been rejected by four doctors to be accepted as a patient based solely on my trans status, and that is in NYC. Think about if people wouldn’ t accept you as a patient because you are an immigrant or ( gasp) a politician. ”
Going back to the trans experience, Schneier says: “ Despite that, I am so grateful to live in a free country where transitioning is possible. Sen. Ted Cruz’ image of America seems to be one where families and individuals should have their health rights determined by the State. People don’ t transition to fit some secret agenda. I transitioned because the alternative would have been living with major depression for the rest of my life. All that I am asking for is that people respect my rights as an American to make decisions about my own personal health and wellbeing. ”
And with the subject of identity, Schneier is keen to clarify: “ So how do I identify? I am a father. I am an employer. I am a New Yorker. I am a husband. I also happen to be trans. It is a part of my life, but it is not what defines the entirety of me. My only agenda these days is to try to get my son to take out the trash without me asking him. I hope one day the extreme Right in America realizes that their actions against trans people are anti-American to their core, but even if they don’ t I will continue to build companies and fulfill my life’ s dreams, because I am an Am. ”
Dr. Tim Sandle is Digital Journal's Editor-at-Large for science news. Tim specializes in science, technology, environmental, and health journalism. He is additionally a practising microbiologist; and an author. He is also interested in history, politics and current affairs.
Under a shattered crescent hanger at Ukraine's Gostomel Airport the world's largest plane lies buckled and broken.
A federal appeals court upheld Biden’ s vaccine mandate for federal workers, while COVID-19 cases rise.
The fake logic is simple to the point of idiocy, but it’ ll work in information-starved Russia.
At least 52 people are killed, including five children, in a rocket attack on a train station in the eastern Ukrainian city of Kramatorsk.
COPYRIGHT © 1998 - 2022 DIGITAL JOURNAL INC. Digital Journal is not responsible for the content of external sites. Read more about our external linking. | general |
Pfizer Inc Stock Quote: PFE Stock News, Quotes, Analysis | Pfizer Inc ( PFE) - DEVELOPS BIOPHARMACEUTICAL PRODUCTS THAT OFFER MEDICINES AND VACCINES IN VARIOUS THERAPEUTIC AREAS.
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The Omicron variant ignites fears that currently available COVID-19 vaccines and treatments could be less effective against it. MRNA, PFE, BNTX, REGN and JNJ are some of the industry players gearing up to fight against this new variant.
Pfizer ( PFE) reported earnings 30 days ago. What's next for the stock? We take a look at earnings estimates for some clues.
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Moderna ( MRNA) shares decline following a two-day rise as the Omicron-variant creates uncertainty with limited data. The next couple of weeks may provide a clearer picture.
Go beyond breakouts and learn about 4 buy signals for early entries and adding on. | business |
LEGACY Insights: COVID Lockdowns in China, State of West Coast Ports, Russian-Ukraine Invasion | Consumer demand for personalized experiences is at an all-time high. Faster and more efficient is the order of the day. We’ ve evolved to stay ahead of the curve through strategic growth and expanding our capabilities focusing on three core areas: as a right-sized warehousing & distribution partner…
In last month’ s Shipment, we were carefully monitoring the situation in Ukraine, sharing early predictions about the potential impact of Russian aggression, with particular attention to commodity prices, cybersecurity threats, and cascading geopolitical tensions.
Since the publication of that newsletter, the conflict has escalated into all-out warfare, with Russian President Vladimir Putin ordering the military invasion of Ukraine on February 24, 2022.
In the span of just weeks, multiple Ukrainian territories have fallen under Russian control; major cities - including the capital, Kyiv, Kharkiv, and Mariupol - have been subject to attack; the Ukrainian people have mounted a resistance that has been praised by the world over; anti-war protests have broken out across Russia, and there have been over 15,000 casualties and millions of Ukrainian citizens displaced.
The ripple effects of the crisis have been felt across all corners of the world. Complex global supply chains - already strained under the considerable pressure of the pandemic - have started to crack.
Russia and Ukraine are major suppliers of an extensive list of raw materials, including sunflower oil; wheat; barley; corn; fertilizer; chemical elements such as neon and xenon; and metals such as palladium, platinum, aluminum, steel, and chrome.
With supply chains all but at a complete halt, automakers and semiconductor manufacturers face materials shortages, while rising food prices threaten the populations of poorer nations across Europe, North Africa, and the Middle East. Major companies such as Nestle, Mondelez International, Coca-Cola HBC, and Sumitomo Electric have shut down Ukrainian plants to avoid risk, while countless others - including Verizon, Pfizer, and Deutsche Bank - have suspended operations in Russia in solidarity with the Ukrainian people.
As noted, cargo flights between Europe and Asia have been canceled or rerouted around Russian airspace in observance of no-fly zone restrictions, increasing air freight fuel costs and prompting carriers to opt for smaller and lighter cargo loads as a result.
Though it’ s early yet, these measures - as well as parcel and cargo carriers pulling shipments from Russia - are expected to stretch already limited air cargo capacity even thinner. And we would be remiss not to mention the conflict’ s impact on the European energy market: Russia is one of the world’ s largest producers of oil and natural gas, and so the crisis has also triggered a precipitous increase in fuel prices.
The full effects of the crisis remain to be seen, but with peace talks making only marginal progress, it is fair to say that shippers would do well to expect the conflict to continue for the foreseeable future and plan accordingly.
Note: Though the Russian invasion of Ukraine is certainly an important topic within the logistics industry, out of respect for the people directly affected by the conflict, we can not have any sort of meaningful discussion about its economic impact without first acknowledging its human impact. There has been an incalculable loss of human life, and the situation is, by anyone’ s account, a tragedy. The Legacy team stands with those impacted by the violence and hopes for a peaceful resolution.
Welcome, everyone, to the April 2022 edition of the Legacy Monthly Shipment - the place for breaking logistics industry trends and insights.
Issue 24: COVID Lockdowns in China, The State of West Coast Ports & More.
February 2022 Brings Second-Highest Reading in LMI History.
“ Stealth Omicron ” Fuels China’ s Biggest Covid-19 Outbreak in 2 Years.
Southern Californian Ports Experience Brief Reprieve after Months of Congestion.
White House Unveils New “ Freight Logistics Optimization Works ” Initiative. | general |
ARR financings make a splash in European mid-market | The rise of direct lending funds continues to be scrutinized from all sides of the market, especially as they now compete fiercely with broadly syndicated loans and bonds, as well as bank-based credit in general.
Indeed, direct lenders have shown a willingness to provide jumbo unitranche deals of £1 billion-plus, putting them in direct competition with underwriting banks. A combination of macro events has further forced banks to retrench from lending, thereby creating a fertile environment for direct lending funds to proliferate.
However, it is in the lower end of the European mid-market where competition between funds is really playing out. This dynamic is bringing innovations, with lenders looking at new metrics of company performance such as annual recurring revenue ( ARR) rather than a standard EBITDA measure, with deals done on this basis adding to a growing cohort of 'ARR financings '.
“ While it’ s true that direct lenders generally are seeking to deploy via bigger tickets, some lenders that are newer to the ARR space are willing to look at smaller deals as a way of dipping their toe into the ARR market, ” said Steve Green, senior director at Alvarez & Marsal. “ Undoubtedly, as these lenders become more comfortable with ARR over time, they will revert to seeking the larger tickets. However, for now the smaller deals are a neat way for these lenders to gain experience and better understand the market dynamics. ”
Most direct lending funds are looking into deploying ARR financing, market sources agree. “ I am looking at ARR at the moment — we all are, ” confirmed one direct lender.
“ We are getting more and more queries from our mainstream clients who want to know how these ARR deals work, ” said Francis Booth, partner at Hogan and Lovells.
ARR financing was spawned in the U.S., and more particularly in Silicon Valley — where technology companies are legion. Technology firms tend to be resilient and have withstood the COVID-19 pandemic well, and are also the companies that will more likely have the kind of clearly identifiable, recurring revenue based on subscriptions which is the corner stone of ARR financings. “ A gross profit or pre-EBITDA business whose revenue doesn’ t truly ‘ recur’ could be seen as weaker credit, ” explains Aymen Mahmoud, partner at MWE.
“ Tech has been a fantastically resilient sector over the course of the pandemic and that's what's bringing people to have a look at ARR and try and understand the businesses and the credit thesis, whereas before, they might have left them, ” Booth says. “ Over the last few years, it’ s been a less crowded market place in Europe — but that looks set to change, ” he added.
Furthermore, ARR financing makes it possible to tailor a package that is not based on EBITDA — such in cases where companies would have no EBITDA or a negative figure, for example — on the premise that such a company is on route to generate a lot of revenue, and soon enough EBITDA.
“ Assuming there is mandatory flip to an EBITDA-based leverage test, there is generally also a window in which the borrower can elect to flip, ” says Booth. “ That may unlock the margin ratchet, grower baskets and dividend permissions, but there may also come a point where the business is finally turning a profit and it’ s actually easier for the CFO to meet the EBITDA test than it is to keep growing revenue to meet the ARR test. That all depends of course on the profile of the ARR test. ”
Meanwhile, competition for financings is driving up ARR leverage multiples. These generally began in Europe around 1/1.5x, but the market is already seeing deals going up to 3x ARR. “ Whilst ARR leverage multiples started off relatively modest in Europe, they now often start with a 2 and are also getting done at 3x ARR. Some borrowers are also able to negotiate ARR for life, and not just in the VC space, Booth said.
“ The market has moved from requiring a flip to EBITDA-based covenants after two or three years to more ARR-for-life structures as sponsors seek to drive value via top-line growth — particularly given most of these assets are valued based on ARR multiples, ” said Alvarez & Marsal's Green.
As for covenants on such deals, these are a bit different from plain vanilla unitranche financings, but otherwise work in the same way, market sources agree.
Lenders such as Sixth Street, Blackrock and Silicon Valley Bank have been active in the ARR financing space for several years, however there are an increasing number of direct lenders beginning to look at the space, sources say. “ Some lenders that are keen to do more in the ARR financing space are somewhat restricted by the mandate of their funds, which don’ t cover such structures, ” explains Green. “ But it is likely that as part of new fundraising processes lenders will increasingly look to include the ability to invest in ARR financings. ”
In terms of pricing for ARR financings, the market seems to agree that this is roughly lining up with conventional unitranche packages, or perhaps coming a little higher. “ There is some 25-50 bps on top for ARR, ” another direct lender said.
Among recent examples of ARR financings, Marlin Equity Partners has this week raised debt financing to support the future growth and recapitalization of its portfolio company Heimdal Security, a provider of cloud-based cybersecurity. And in January, Marlin acquired a majority stake in Silobreaker, a risk and threat intelligence SaaS provider, to support its continued growth strategy, with an ARR financing used.
Elsewhere, there was also an ARR financing supporting Corten Capital’ s acquisition of Matrix42, one source said.
The level of interest that ARR financing is generating from all parts of the private lending market means it is already evolving quickly, and will be an area to watch closely as the year progresses. | business |
Climate, Energy, and Environment | Your contribution makes it possible for the Center’ s researchers to devise practical, evidence-based solutions for today’ s most pressing development challenges.
The effects of climate change are already being seen throughout the world, and it is clear that a fundamental change in the world’ s economy will be needed if the planet is to survive. Lower income countries will be among those most affected by climate change; yet they have contributed least to global emissions, with the poorest 52 countries, home to 1.4bn people contributing less than 2% of global emissions.
Alongside the climate challenge, around half of the population in Least Developed Countries lacked access to electricity in 2018, with over 500 million people lacking any access to power in Africa alone. Most of those living in rural areas of low-income countries still derive their living from agriculture where the sector accounts for over 30% of GDP. Environment and development interventions often have synergies but can also face trade-offs.
As the world adjusts to a new climate reality, CGD experts are exploring the role climate finance and wider economic policy can have in assisting developing countries to adapt to whatever economic order may emerge. How can higher income countries and international financial institutions best support developing countries confronting the challenges of climate change? How can the COVID-19 recovery support the changes needed for long-term resilience and sustainability? | general |
Valcon develops data platform for Covid-19 vaccination roll-out | Valcon has supported the National Institute for Public Health and the Environment ( RIVM) in the Netherlands with the development of a data platform that facilitates the distribution and roll-out of Covid-19 vaccinations.
On January 6th 2021, the first Covid-19 vaccine shot was administered in the Netherlands. Shortly before that, the Logistics Coordination Centre ( LCC) of the RIVM was set up. This is the beating logistical heart of the National Immunization Programme. Delivery, quality control, distribution over vaccination locations and planning are among the core tasks of the centre.
The Logistics Coordination Centre coordinates the entire supply chain of the roll-out, from storage of the vaccine to the disbursement of the vaccine.
This logistical operation was partly supported by the Ministry of Defence. Vaccination orders from various suppliers were delivered daily and stocked in cold stores. In addition to the incoming flow, there was also an outgoing flow to the various vaccination locations.
When dispensing, the storage time of the vaccine outside the refrigeration units should be monitored as each vaccine has its own characteristics and storage requirements. The vaccine was also very scarce, and it had to be used as efficiently as possible without creating a surplus at a location.
As a result, it was a massive and complex job to draw up and keep pace with the planning. This planning was initially based on manual output from the registration system and required subsequent manual data entry in Excel – a time-consuming and error-prone process.
In January 2021, the Logistics Coordination Centre asked Valcon and Delta-N to support with professionalising this process. The two companies were selected for their proven track record and experience gained at the National Consortium for Medical Aids ( LCH) and the National Coordination Centre for Intensive Care Patient Distribution.
The project kicked off with the development of a mock-up PowerBI dashboard based on test data. A period of three weeks was agreed for this. The purpose of this assignment was to present the possibilities of the different insights to the programme management of the RIVM ( on behalf of the director of the National Immunization Programme).
The goal was to expedite the planning process and provide more accurate insights into the logistics process. However, with Covid-19 developments unfolding rapidly, the need for correct and accurate insights became so important that the deadline of three weeks was shortened to just one week.
At the end of the first week, a first version of the mock-up dashboard was presented to the programme management. Several demands were discussed and eventually the management asked if they could use the dashboard in their consultation with the Dutch Minister of Health, Welfare and Sport.
The RIVM, Valcon and Delta-N team did not hesitate for a minute; pizzas were ordered, exemptions for travel curfews ( at that time applicable) were arranged and the team commenced on their – very strategic – challenge. Following a ‘ pressure-cooker’ week, the deadline was met – a result the team can still pride itself on.
The planned activities to roll out a solid Microsoft Azure Data Platform were immediately moved up in the project schedule. Various lines and processes were started within RIVM to clear the way for the implementation of the platform.
As Microsoft Azure Cloud solutions was relatively new for RIVM, focus was also given on building ‘ buy-in’. In collaboration with Microsoft ( Chief Information Security Officer and architects), several sessions were held with the RIVM team to jointly agree on a scalable and secure solution to implement going forward.
The development team, a team of employees from Valcon and Delta-N, developed the Microsoft Azure Data Platform solution in collaboration with colleagues from RIVM. Various sources have been made available through the platform and various PowerBI dashboards have been delivered.
The added value of a Microsoft Azure Data Platform for the Logistics Coordination Centre has proven itself – it guided the decisions at a national and local level, and even provided guidance to parliamentary debates and questions. The PowerBI dashboards also supported the planning department with the necessary insights to be able to plan more efficiently and accurately.
The project was staffed by several Valcon consultants, including Roy Thomassen, Carl Laudy, Marjon Meulmeester, Thomas Kamerling, Jurren Pen, Marijn Kroes, Michiel Heijl, and Twan van Rossum.
“ The strength of the collaboration between Microsoft, RIVM, Valcon and Delta-N has contributed to the fight against the Covid-19 virus and served a social purpose. We proud to have been able to contribute to this, ” staed Valcon’ s project manager on the engagement.
The project has been nominated for the Microsoft Partner of the Year 2022 award. | general |
How Toyota is managing an unprecedented global supply chain crises | There's a giant whiteboard on the wall in a Michigan office building where the problems of the world are listed and tracked in minute detail.
The colorful papers hanging there — tracking earthquakes and tsunamis, fires and floods, coronavirus hot spots and even wars — aren't just the world's problems, though.
They're Bob Young's problems, today and every day.
Young, the group vice president of purchasing supplier development for Toyota Motor North America, and his team in the town of Saline are charged with keeping the region's assembly and components plants running as much as possible. And for more than two years now, through COVID-19, a string of natural disasters, civil strife, labor shortages and now a war between Russia and Ukraine, Young's job has been challenging.
`` Normally, our world is some level of controlled chaos, but the last few years, it's been a little more chaotic than what we're used to, '' Young said last month with what seemed to be an exhausted chuckle.
His whiteboard on March 21 was tracking at least 70 threats to the production and delivery of Toyota and Lexus vehicles to U.S. dealerships.
Illustrating how these events are affecting its manufacturing, Toyota Motor Corp. last month announced global April production would be cut by 150,000 vehicles, to 750,000, and output will be down 10 percent in May and 5 percent in June from estimates made at the beginning of the year. The next day, after Japan was rattled by a 7.4-magnitude earthquake, the company said it would halt production for three days starting on 18 lines at 11 factories there and lose 20,000 units of production.
Young's `` laundry list of issues '' wasn't surprising — semiconductors, labor availability, disruptions in global and regional logistics, natural and human-made disasters — but it seems to keep expanding in the face of conventional wisdom that the threat of major disruptions from the pandemic is fading.
So what gives?
`` I think in general, because of all of the challenges that we 've had — whether it's cyberattacks or natural disasters or you name it — the supply chain is still relatively fragile. And I would say many suppliers aren't in a full condition when it comes to work-in-process inventories or finished goods, '' Young said. `` So the first slight hiccup, it's very close to causing us problems. ''
Toyota, which operates one of the industry's most complex global supply and logistics chains, has been running with the leanest inventories in the U.S. for most of the last year, with only fellow Japanese brand Subaru running with fewer days ' supply at dealerships. Longtime executive Bob Carter, head of sales for Toyota Motor North America, joked recently that, until last year, he `` had no idea our system could even measure days ' supply in tenths '' of a day. | general |
Amazon workers in New York vote to unionize in US first | Hi, what are you looking for?
Employees at the Staten Island JFK8 warehouse voted 2,654 to 2,131 in support of the unionizing drive, according to a tally of ballots.
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Amazon workers in New York voted Friday to establish the first US union at the e-commerce giant, a milestone for a company that has steadfastly opposed organized labor in its massive workforce.
Employees at the Staten Island JFK8 warehouse voted 2,654 to 2,131 in support of the unionizing drive, according to a tally of ballots from the National Labor Relations Board.
At stake was Amazon’ s ability to remain union-free in its home market, a status it has guarded fiercely since the company was set up in the 1990s.
“ Welcome the 1st union in America for Amazon, ” organizer Christian Smalls tweeted.
During the contentious campaign, the company discouraged workers from supporting unions at mandatory meetings, and through signs and other literature at the work site.
Amazon has argued that forming a union will mar the company’ s direct relationship with workers and represent a jump into the unknown, with no guarantee employees will wind up with better wages or job security.
The overall picture for organized labor in the United States is no better than mixed in an economy that has seen unions’ share of the American workforce steadily diminish in recent decades.
– Union revival? –
The number of US workers who are members of a union has fallen from about 20 percent in 1983 to about 10 percent in 2021, according to the Bureau of Labor Statistics.
At Amazon, workers at a Bessemer, Alabama warehouse last year overwhelmingly voted against a unionization push supported by the Retail, Wholesale and Department Store Union.
But the NLRB later called for a redo of the vote, citing what it called interference by Amazon.
In the Alabama re-vote 993 workers cast ballots against the labor group, compared with 875 employees in favor.
But there were 416 “ challenged ” ballots, a “ determinative ” amount, according to the National Labor Relations Board, meaning the number of ballots still to be settled is big enough to potentially decide the final result.
At a news conference Thursday, union officials noted that their initial campaign last year — which received lots of media coverage and even an official endorsement by President Joe Biden — helped spur similar moves around the country.
At Starbucks, a movement to shift labor dynamics began with two cafes in upstate New York voting in December to unionize. Since then, more than 150 restaurants are at various stages of union campaigns.
The Starbucks campaign was led mostly by younger and college-educated workers who are broadly reflective of the current wave of newer labor supporters.
Union campaigns have also had recent success at museums, NGOs, media companies and universities.
But beyond those sectors, labor unions have struggled to gain a foothold, particularly in southern and some western states, whose percentage of unionized workers are less than one-third or one-fourth of those in California and New York.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
Under a shattered crescent hanger at Ukraine's Gostomel Airport the world's largest plane lies buckled and broken.
A federal appeals court upheld Biden’ s vaccine mandate for federal workers, while COVID-19 cases rise.
The fake logic is simple to the point of idiocy, but it’ ll work in information-starved Russia.
At least 52 people are killed, including five children, in a rocket attack on a train station in the eastern Ukrainian city of Kramatorsk.
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A Bank for the World: How the Business Model of the World Bank Group Can Better Respond to Global Challenges | This event is co-hosted by the Norweigan Ministry of Foreign Affairs, the German Federal Ministry for Economic Cooperation and Development ( BMZ), and the Center for Global Development, as part of the World Bank 2021 Annual Meetings, and features CGD Board Chair Lawrence H. Summers, CGD President Masood Ahmed, and CGD Executive Vice President Amanda Glassman. More information on participation can be found at this link.
Global challenges like pandemics, climate change, conflict and war require global collective action. The World Bank, built around the country loan as the key product, has had neither the core mandate nor the adequate financing modalities needed to systematically respond to these challenges. A high-level independent panel commissioned by the G20 recently made a set of recommendations for the Bank’ s future role in global public goods, such as pandemic preparedness in its report “ A Global Deal for Our Pandemic Age ”. Earlier panels have made similar points ( G20 EPG-Full Report.pdf ( globalfinancialgovernance.org); Multilateral Development Banking for this Century's Development Challenges: Five Recommendations to Shareholders of the Old and New Multilateral Development Banks | Center For Global Development ( cgdev.org)). With the protracted COVID-19 pandemic, there is new urgency for the World Bank to move ahead on these recommendations to build a green, resilient and inclusive future for all.
Ahead of the World Bank’ s Development Committee meeting, this panel will bring together G20 high level independent panel ( HLIP) members, global experts, shareholders, and World Bank management to discuss the role of the World Bank in incentivizing investments and promoting structural reforms to integrate global challenges at the core of a revamped World Bank business model. How can existing commitments to meet global goals be operationalized as part of the World Bank’ s Green, Resilient and Inclusive Development ( GRID) approach? What is the World Bank’ s comparative advantage and where can the Bank create clearer synergies with other multilateral and client country partners? As World Bank Group President Malpass asked, “ how does the world help poorer countries make larger investments in global public goods and how should the costs be shared worldwide? ” What are the implications for the World Bank’ s business model including for concessional financing by the International Development Association ( IDA), the GPG Fund, trust funds, FIFs and external providers of concessionality such as the Climate Investment Funds ( CIFs)? | general |
'Finally we can protect women ': Japan's HPV vaccine battle | Hi, what are you looking for?
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Thousands of lives could be saved as Japan begins to actively promote the HPV vaccine — which can prevent cervical cancer — after a decade of misinformation and weak policy left inoculation rates dismally low, advocates say.
The percentage of teenage girls getting the human papillomavirus ( HPV) vaccine has been close to zero since the country’ s 2013 decision not to promote the jab as panic erupted over alleged side effects.
But from Friday, authorities will actively recommend and share information about the vaccine, which is free for girls aged 12-16 in Japan and has been found safe in extensive trials.
“ Finally we can protect the lives of young women, ” ruling party politician Junko Mihara, a former vice health minister and cervical cancer survivor, told AFP.
Even then, “ we will lose so many lives because of the past eight years, ” she said.
Nearly always caused by sexually-transmitted HPV, cervical cancer is the fourth most common type of the disease in women globally.
In Japan, around 10,000 women develop cervical cancer each year, and it causes nearly 3,000 deaths.
Yet the World Health Organization regards the disease as “ preventable and curable ” and has outlined a strategy to eliminate it, which includes having 90 percent of girls inoculated by the age of 15 by 2030.
More than 100 countries have started using the vaccine, including Britain, where cervical cancer cases have already plummeted among women who received the jab, according to a recent study in The Lancet medical journal.
– Misinformation –
When Japan added the HPV vaccine to its national programme of routine inoculations in April 2013, initial uptake from the target group, girls aged 12-16, was around 70 percent.
But the government stopped actively promoting the jab just two months later, as sensationalist reports of alleged harmful side effects spread fear among the public.
It was still available for free, but without official endorsement, take-up soon dropped to less than one percent.
“ The health ministry placed more emphasis on public opinion than scientific evidence, ” said Kanako Inaba, a gynecologist who runs an organisation providing information on the HPV vaccine.
This week’ s policy shift follows years of campaigning by medics and advocates like Mihara, a former actress who went into politics in 2010 to advocate for the new HPV vaccine.
But she struggled to battle misinformation, with media reports failing to make clear the difference between health problems that occurred after vaccination, and side effects directly linked to the jab.
Families gave emotional accounts on TV claiming the HPV vaccine had left their daughters unable to walk, and pro-vaccine campaigners like Mihara found themselves the target of angry abuse.
“ People came to my office, and faxes kept coming, ” she recalled.
While there have been concerns over Japanese vaccine hesitancy in the past, the success of the country’ s Covid-19 vaccine drive — with 80 percent of the population double-jabbed — shows how influential government policy can be, according to Inaba.
“ The government should have also taken a firm stance on the HPV vaccine, by providing evidence, ” like they did with the Covid vaccine, the doctor said.
Now, as more HPV shots are given, healthcare workers should “ understand that girls might be anxious ” about side-effects, and “ provide information in an empathetic way, ” she added.
– ‘ Not afraid’ –
A 2020 study in The Lancet predicted that Japan’ s “ HPV vaccine crisis ” could result in an additional 5,000 cervical cancer deaths among girls born between 1994 and 2007, compared to if uptake had remained at 70 percent.
The health ministry is trying to minimise the damage by offering free HPV vaccines to women who missed the shot over the past nine years, when they were of target age.
University student Utako Kawakami, 20, wishes she had been vaccinated before becoming sexually active.
Her mother was wary about giving her the shot as a teen due to media reports, although she has now changed her mind.
Kawakami got her second HPV vaccine dose last year, however, and told AFP she “ wasn’ t afraid ”.
“ I made my decision based on data, ” said the 20-year-old, who now posts information about the vaccine on social media for younger followers.
The vaccine’ s promotion still faces some opposition, notably from women who say they suffer pain, fatigue or other conditions after being inoculated.
Several lawsuits have been filed against the government and drugmakers since 2016 over alleged side effects, but no verdicts have yet been made.
For lawmaker Mihara, who had her uterus removed after developing cervical cancer, accurate information is key to boosting the vaccination rate.
“ I don’ t want younger people to go through what I went through, ” she said.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
That’ s the real danger. Nobody trusts Russian judgment anymore.
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Assessing Biden's Sophomore International Affairs Budget | President Biden sent his second budget request to Congress this week. We dug in to see how some of CGD's most-watched accounts would fare and how the administration's funding asks reflect on its development and humanitarian policy agenda.
Though lawmakers ( infuriatingly) have yet to act on the administration's request for urgent supplemental funding to combat COVID-19 at home and abroad, the new budget request from the White House charts a course for more robust, longer-term investment in pandemic preparedness and global health security. Hoping to head off future health threats and limit the need for ad hoc response spending, the administration's bold proposal envisions tens of billions in mandatory funding ( shielded from the sometimes fickle annual appropriations process) available over five years to support programs across several departments and agencies. New resources would be used for everything from improving surveillance and streamlining regulation to advancing our ability to fight emerging health threats through the development of new countermeasures. And the ask for five-year mandatory funding includes $ 6.5 billion for the State Department and USAID—including $ 4.5 billion for a seed contribution to a new financial intermediary fund ( FIF) at the World Bank focused on pandemic preparedness.
The concept behind the FIF—championed by a G20 High-Level Independent Panel ( with CGD participation) and a number of leading global health experts—is to provide financing to support and incentivize low- and middle-income country investment in the yawning gaps in pandemic preparedness and to allocate funds across the system to a range of recipients. While this kind of catalytic, multilateral health security financing mechanism has found bipartisan allies on Capitol Hill before, current negotiations over near-term COVID response needs suggest securing mandatory funding will be a big lift. Still, this is exactly the kind of proposal lawmakers should embrace to protect public health and reduce the need for emergency supplemental spending measures. And demonstrated leadership from the United States can help mobilize contributions from other donor countries. Sustained, collective investment is the best chance we have for getting ahead of emerging health threats and guarding against future pandemics.
The requested mandatory spending for USAID would provide for a $ 500 million contribution over five years to the Coalition for Epidemic Preparedness Innovations ( CEPI) —a multilateral alliance with a mission to accelerate vaccine development to stop future health threats. Amid CEPI's success developing a diversified portfolio of COVID-19 vaccine candidates and mitigating some key manufacturing risks, there’ s a strong case to make for further US investment.
Table 1. Global health topline ( USD millions)
Note: For all tables and graphs in this blog post, figures may be rounded and do not include supplemental spending.
The regular, discretionary global health budget also includes nearly $ 1 billion for global health security—with $ 250 million earmarked for a contribution to the FIF. The budget request's topline global health figures would provide a modest increase in spending, with the lion's share accounted for by the first installment of a three-year $ 6 billion commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
* FY21 enacted levels do not include emergency supplemental funding.
The FY23 budget request includes increases for both Development Assistance and the Economic Support Fund, with the largest boost to countries in the Western Hemisphere. The ask aligns with the administration's efforts to address the root causes of irregular migration from the Northern Triangle—and President Biden's campaign pledge to invest $ 4 billion in Central America over four years. Last year, the administration released a dedicated strategy intended to help guide programming in the region.
Evidence has revealed a number of ways in which foreign assistance can help address some of the challenges facing El Salvador, Guatemala, and Honduras. But one of the most promising approaches shown to relieve the pressure to migrate irregularly is to offer safe, legal pathways for migration. So it continues to be encouraging to see the importance of labor mobility factored into the administration's agenda. In fact, the congressional budget justification notes the value of expanding legal pathways and labor protections for migrants as part of this work. But it's worth noting that success on that front could hinge, at least in part, on other line items in the administration's budget—including funding to support US Citizenship and Immigration Services as it works through massive backlogs exacerbated by pandemic-driven closures and shortfalls facing its historically user-fee-funded budget.
Other proposed allocations from these core accounts reflect mounting concerns about China's growing global influence. The administration is hoping to allocate $ 250 million for a fund named for its Build Back Better World ( B3W) initiative, which aims to provide developing countries with an alternative to the People's Republic of China's ( PRC) Belt and Road Initiative. And the administration is seeking a $ 127.5 million investment in the Countering PRC Malign Influence Fund to help countries confront coercive economic and unfair trade practices. Given enormous financing gaps in infrastructure across much of the world, increased US attention in this area is welcome. But the administration must ensure that what's on offer is a credible alternative—transparent financing to deliver high-quality, sustainable infrastructure. And to deliver on that, the administration should look to harness financing through the multilateral development banks since the amounts available bilaterally are extremely modest compared to China’ s overseas lending through Belt and Road.
President Biden's request would increase US commitments to the multilateral development banks by nearly a quarter compared to the level enacted in the omnibus spending bill. This increase is driven entirely by a boost for the World Bank's International Development Association ( IDA) —and with good reason. As the financing needs of IDA client countries—the world's lowest income countries—grew amid the COVID-19 pandemic, the World Bank's shareholders, including the United States, agreed to move IDA's planned replenishment session up by a year. This accelerated timeline allowed IDA to deliver urgent support sooner—helping countries meet immediate health needs and weather the profound economic and poverty challenges triggered by the global health crisis. But since IDA replenishments typically operate on three-year cycles, the decision created an interesting quandary for the US administration. The United States had been scheduled to make a final payment toward its IDA-19 pledge in the coming fiscal year. The advance replenishment meant it would also be looking to double up contributions, delivering the first installment of its three-year, $ 3.5 billion IDA-20 pledge in the same year.
Rather than risk the sticker shock of a `` double payment '' to IDA, the administration decided to backload its payments to IDA-20. It also transferred a modest amount of unobligated funding made available through the American Rescue Plan—appropriately intended to support COVID response—toward its FY22 IDA-19 payment. Doing so effectively smooths the ask made of appropriators. While this year's request of $ 1.43 billion will, in a sense, be split—with $ 791 million dedicated to fulfilling the US pledge to IDA-19 and $ 640 million as an initial investment toward its IDA-20 commitment—we can expect a similar ask of $ 1.43 for IDA from the administration in FY24 and FY25 to finish out the final two years of the IDA-20 replenishment period. Still, it will be important that Treasury socialize plans with lawmakers to ensure they appreciate the vital support IDA is providing countries around the globe during a particularly challenging period—while noting that the boost in financing was made possible by the promise of new donor funding on the horizon.
Even aside from the IDA bump, the budget's topline for multilateral assistance suggests new ambition—but it’ s heavily concentrated in climate finance. Despite a frustrating FY22 outcome, the proposed FY23 budget doubles down in its effort to meet President Biden's $ 11 billion international climate finance target. The request includes $ 1.6 billion for a contribution to the Green Climate Fund and $ 550 million for the World Bank-administered Clean Technology Fund—most of which is intended for a loan that would deliver impressive leverage while supporting clean energy projects in lower income countries.
* FY20 and FY21 enacted levels do not include emergency coronavirus response supplemental funding.
When the final FY22 spending package was released, among the biggest disappointments—outside of the failure to include COVID-19 response funding—were its cuts to major humanitarian accounts, namely International Disaster Assistance and Migration and Refugee Assistance. Amid a growing number of protracted conflicts and emerging crises, this funding is as important as ever. The administration's FY23 budget request seeks to increase both accounts—asking for nearly $ 4.7 billion for USAID's International Disaster Assistance, which supports humanitarian response efforts around the world, including in Afghanistan, Northern Ethiopia, Yemen, Syria, and Venezuela.
While a portion of supplemental spending for Ukraine was intended to meet humanitarian needs, the number of people forced to flee Ukraine in the wake of Russia's invasion is unprecedented. And sadly, it adds to large populations of displaced persons around the world—making US leadership in supporting refugees even more vital. A modest share of the Migration and Refugee Assistance Account also supports the US Refugee Admissions Program. As the US looks to build back its refugee resettlement infrastructure, a boost there is essential. Likewise, while not funded through the international affairs budget, the request includes $ 6.3 billion for the Office of Refugee Resettlement. As recent CGD research shows, increasing US refugee resettlement isn't just a humanitarian win but an economic one.
Finally, the administration is looking to shore up the Emergency Refugee and Migration Assistance account after needing to tap the reserve fund to meet urgent needs, including those stemming from the humanitarian crisis in Afghanistan.
Table 2. Millennium Challenge Corporation ( USD millions)
The Millennium Challenge Corporation ( MCC) would see a top-up of $ 18 million compared to the last two years. If funded at this level, it would be MCC’ s largest appropriation since FY10. It would be welcome, too, coming on the heels of the FY22 spending bill, which delivered on a requested recission of $ 515 million in unobligated money previously appropriated for the agency. While much of the rescinded funding had been intended for a compact with Sri Lanka that never got off the ground, our colleague Sarah Rose voiced concern that the move could discourage MCC from cutting the cord on bad partnerships in the future. MCC would use FY23 funding to finance forthcoming compacts in Indonesia and Mozambique. The agency has also promised that half of its funding will go toward climate-related investments.
The White House is again seeking an increase in resources for the newest US development agency. After requesting a bump up in administrative expenses for DFC in its first budget request, the administration submitted a request for anomalies in September that outlined the need for increases to administrative and program accounts in the context of a continuing resolution. The final FY22 spending package provided some additional funding for DFC, but the administration is hoping to raise the agency's topline to $ 1 billion in FY23. The proposal is a welcome acknowledgment from the White House that DFC has a lot on its plate. And judging by the frequency with which DFC is invoked—during all manner of congressional hearing—Capitol Hill seems keen on pursuing an ever-expanding role for US development finance. Ensuring that DFC has the resources to deliver will be critical. DFC's inspector general—whose office would also receive a funding boost—recently penned a letter to CEO Scott Nathan, acknowledging the high bar set by DFC stakeholders and pointing to the need to improve the agency's monitoring and evaluation capacity. DFC is actively growing its workforce and will need to cultivate expertise and project pipelines in a range of sectors and regions to have a chance at meeting sky-high expectations. A budget boost would go a long way in supporting the administration's broad agenda for DFC.
If USAID is to meet today’ s global development challenges, it needs a robust and knowledgeable global workforce. And with the agency’ s commitment to expand direct partnerships with local organizations as part of its work to advance locally led development—a goal that requires significant personnel time—staffing up will be critical. The president's request includes $ 1.74 billion in operating expenses for USAID—which will enable the agency to hire 100 more civil servants and 100 more foreign service positions. This increase would follow another bump up in funding for operating expenses between FY21 and FY22.
Here are a few other parts of the budget request that caught our attention.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions. | general |
Ukraine war pushes eurozone inflation to new record | Hi, what are you looking for?
Spiralling energy bills and disruptions caused by the war in Ukraine caused consumer prices in the eurozone to surge by a new record of 7.5 percent.
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Spiralling energy bills and disruptions caused by the war in Ukraine caused consumer prices in the eurozone to surge by a new record of 7.5 percent, EU statistics agency Eurostat said Friday.
Last month’ s rise marked a further acceleration in inflation from February, which at 5.9 percent year-on-year was already a eurozone record, it said.
The surge has been fuelled by a 44.7-percent hike in energy prices over the year as Europe found itself caught in an oil and gas crunch due to tensions with Russia over its invasion of Ukraine.
European Central Bank ( ECB) president Christine Lagarde warned Wednesday that a prolonged Ukraine conflict will keep energy prices and the cost of living spiralling, blighting a post-Covid recovery.
Similar leaps in inflation have been seen in the United States where the Federal Reserve is committed to a long series of interest hikes to cool the economy and stem the price hikes.
But the ECB is reluctant for now to take similar measures, convinced that the rise in the cost of living is linked to the war as well as lingering disruptions to the global supply chains brought on by the coronavirus pandemic.
But given inflation’ s relentless pace, analysts said Lagarde would soon have no choice but to rethink her policy.
“ With euro-zone inflation rising even further above the ECB’ s forecast, and likely to remain very high for the rest of the year, we think it won’ t be long before the Bank starts raising interest rates, ” said Jack Allen-Reynolds at Capital Economics.
– ‘ No painless options’ –
Of particular concern for policy makers is core inflation, which strips out volatile components such as energy and food. It soared to 3.0 percent in March, Eurostat said.
This is a full percentage point on top of the ECB’ s target of two percent and will give armour to critics that argue for interest hikes to face down inflation.
“ The inflation data speak for themselves, ” said Joachim Nagel, the central bank governor from Germany, Europe’ s biggest economy that traditionally wants stronger medicine against higher prices.
“ Monetary policy should not pass up the opportunity for timely countermeasures, ” he said.
But economists warn that raising interest rates would put the brakes on the post pandemic recovery, with officials already warning that current forecasts for growth in Europe are certain to take a hit due to the war.
“ The question is whether the worst is behind us now and that seems doubtful, ” said Bert Colijn of ING bank.
“ The ECB is running out of painless options to battle current economic problems, so we expect it to tread carefully, ” he added.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
That’ s the real danger. Nobody trusts Russian judgment anymore.
The UN refugee agency UNHCR says 4,656,509 Ukrainians have fled since Russia invaded on February 24 - Copyright AFP FARJANA K. GODHULYRobin MILLARDMore than...
AI, facial recognition, and biometrics can help the world get back to work.
Sri Lanka urged its citizens overseas to send home money to help pay for desperately needed food and fuel.
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Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England ( COPe-support): a randomised clinical trial - The Lancet Digital Health | BackgroundPsychoeducation delivered face-to-face is effective in alleviating mental health morbidities in family carers of individuals with psychosis. However, research in such interventions delivered online is scarce. We evaluated the effectiveness of a digital multicomponent intervention—COPe-support—in improving carers ' mental wellbeing and caregiving-related outcomes.MethodsIn this two-arm, individually randomised, superiority trial, people aged 18 years or older who provided at least weekly support in any format for a relative or close friend affected by psychosis across England were randomly assigned ( 1:1) to either COPe-support or a passive online information resource using an independent online system. Participants were recruited through 30 mental health UK National Health Service trusts. The study team were masked to allocation and assessment of outcomes as all data collection took place online. Participants had access to either condition for 40 weeks and were advised to spend at least half an hour per week over the initial 20 weeks to go through materials at their own pace and to allow time to integrate knowledge and skills learned into practice. It was not feasible to mask participants or the online facilitator to intervention allocation. COPe-support provided psychoeducation on psychosis-related caregiving strategies and forums with professionals and other carers, and the control intervention comprised a passive online information resource. The primary outcome at 20 weeks was mental wellbeing measured by the Warwick-Edinburgh Mental Wellbeing Scale ( WEMWBS; minimally clinically important difference [ MCID ] 3). This trial is registered with ISRCTN, 89563420.FindingsBetween March 1, 2018, and Feb 14, 2020, 407 participants were randomly assigned, with 204 allocated to COPe-support and 203 allocated to control. The participants ( mean age 53·1 years, SD 13·2) were mostly female ( 330 [ 81% ] of 407 participants) and White ( 359 [ 88% ] of 407 participants). 346 ( 85%) of 407 participants provided primary endpoint data, 174 ( 85%) of 204 participants in the COPe-support group and 172 ( 85%) of 203 participants in the control group. The mean WEMWBS score at 20 weeks was 44·5 ( SD 8·31) for the COPe-support group and 43·3 ( 9·19) for the control group. We found no evidence of a difference in wellbeing between the two groups ( adjusted mean difference 0·37, 95% CI –1·14 to 1·88; p=0·63). In the COPe-support group, 106 ( 52%) of 204 participants met the complier definition of a minimum of two logins in separate weeks. The complier average causal effect analysis increased the difference in WEMWBS scores ( adjusted difference 0·83, 95% CI –1·45 to 3·11; p=0·47), but this was lower than the MCID. There were no adverse events.InterpretationOur findings did not support the use of COPe-support over a passive online information resource. However, further research to optimise digital interventions adjunctive to face-to-face support for carers remains important.FundingNational Institute for Health Research.
Psychoeducation delivered face-to-face is effective in alleviating mental health morbidities in family carers of individuals with psychosis. However, research in such interventions delivered online is scarce. We evaluated the effectiveness of a digital multicomponent intervention—COPe-support—in improving carers ' mental wellbeing and caregiving-related outcomes.
In this two-arm, individually randomised, superiority trial, people aged 18 years or older who provided at least weekly support in any format for a relative or close friend affected by psychosis across England were randomly assigned ( 1:1) to either COPe-support or a passive online information resource using an independent online system. Participants were recruited through 30 mental health UK National Health Service trusts. The study team were masked to allocation and assessment of outcomes as all data collection took place online. Participants had access to either condition for 40 weeks and were advised to spend at least half an hour per week over the initial 20 weeks to go through materials at their own pace and to allow time to integrate knowledge and skills learned into practice. It was not feasible to mask participants or the online facilitator to intervention allocation. COPe-support provided psychoeducation on psychosis-related caregiving strategies and forums with professionals and other carers, and the control intervention comprised a passive online information resource. The primary outcome at 20 weeks was mental wellbeing measured by the Warwick-Edinburgh Mental Wellbeing Scale ( WEMWBS; minimally clinically important difference [ MCID ] 3). This trial is registered with ISRCTN, 89563420.
Between March 1, 2018, and Feb 14, 2020, 407 participants were randomly assigned, with 204 allocated to COPe-support and 203 allocated to control. The participants ( mean age 53·1 years, SD 13·2) were mostly female ( 330 [ 81% ] of 407 participants) and White ( 359 [ 88% ] of 407 participants). 346 ( 85%) of 407 participants provided primary endpoint data, 174 ( 85%) of 204 participants in the COPe-support group and 172 ( 85%) of 203 participants in the control group. The mean WEMWBS score at 20 weeks was 44·5 ( SD 8·31) for the COPe-support group and 43·3 ( 9·19) for the control group. We found no evidence of a difference in wellbeing between the two groups ( adjusted mean difference 0·37, 95% CI –1·14 to 1·88; p=0·63). In the COPe-support group, 106 ( 52%) of 204 participants met the complier definition of a minimum of two logins in separate weeks. The complier average causal effect analysis increased the difference in WEMWBS scores ( adjusted difference 0·83, 95% CI –1·45 to 3·11; p=0·47), but this was lower than the MCID. There were no adverse events.
Our findings did not support the use of COPe-support over a passive online information resource. However, further research to optimise digital interventions adjunctive to face-to-face support for carers remains important.
National Institute for Health Research.
Worldwide, a large proportion of people provide substantial yet unpaid support and care to family members or friends living with a long-term illness. In the UK, about 1·5 million people are carers supporting an individual with mental ill health.1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar, 2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 3Sin J Elkes J Batchelor R et al.Mental health and caregiving experiences of family carers supporting people with psychosis.Epidemiol Psychiatr Sci. 2021; 30: e3Google Scholar Psychosis, including schizophrenia, is the most common severe mental illness.1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar, 2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar As the onset of schizophrenia peaks in late teenage years or early adulthood, individuals with psychosis often require long-term treatment and support across a range of life domains.1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar, 2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 3Sin J Elkes J Batchelor R et al.Mental health and caregiving experiences of family carers supporting people with psychosis.Epidemiol Psychiatr Sci. 2021; 30: e3Google Scholar, 4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar Carers play a crucial part in sustaining their loved ones ' community-based treatment and promoting their recovery.2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 3Sin J Elkes J Batchelor R et al.Mental health and caregiving experiences of family carers supporting people with psychosis.Epidemiol Psychiatr Sci. 2021; 30: e3Google Scholar, 4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar However, caregiving negatively impacts carers ' health and wellbeing.2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 3Sin J Elkes J Batchelor R et al.Mental health and caregiving experiences of family carers supporting people with psychosis.Epidemiol Psychiatr Sci. 2021; 30: e3Google Scholar, 4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar
Research in contextEvidence before this studyWe did two systematic reviews at the outset of the trial in 2016, one focusing on psychoeducation interventions for family carers of individuals with psychosis or schizophrenia delivered using any medium, and the second focusing on interventions delivered via the internet. For both reviews, we searched ten databases that cover medical and health publications ( MEDLINE, PsycInfo, CINAHL, Embase, Web of Science, ASSIA, Cochrane Central Register of Controlled Trials, National Institute for Health Research—Health Technology Assessment database, Database of Abstracts of Reviews of Effect, and NHS Economic Evaluation Database) and grey literature ( ProQuest dissertations and theses) for studies published in English and Chinese from database inception to Dec 1, 2016. The search terms comprised subject headings, synonyms, and free-text search terms to identify ( digital/e- or m-/web or internet-) psychoeducation interventions for family/informal/unpaid carer * for people affected by schizophreni * or psycho *. Searches were limited to randomised controlled trials. Through both reviews, we identified 32 randomised trials, including 2858 family carers; only one trial that reported an entirely digital intervention with 21 carers ( and 31 patients) was identified. We did a meta-analysis, considering a range of mental health and caregiving-related outcomes. With relevance to this study, pooled results showed that psychoeducation, using a textual or face-to-face delivery format, was superior in reducing carers ' global morbidities ( standardised mean difference [ SMD ] –0·230), perceived burden ( SMD –0·434), negative caregiving experiences ( SMD –0·210), and expressed emotion ( SMD –0·161), compared with usual care. Effects on carers ' mental wellbeing were non-significant but data for this outcome were retrieved from just two trials and 184 participants. Only one trial investigated carers ' quality of life as an outcome. The search that focused on trials of digital interventions targeting family carers was updated on Dec 20, 2020, identifying an additional trial investigating a digital self-management intervention that was facilitated by carer peer workers, but carers ' mental wellbeing was not measured as an outcome. The search was updated on Aug 2, 2021, and the evidence base remains valid.Added value of this studyTo our knowledge, this is the first fully randomised trial to report the clinical efficacy of a digital psychoeducation intervention that provides quality health information and network support from professionals and carers as peers. This trial provides clear evidence that a multi-component psychoeducation intervention delivered entirely online is not effective in improving carers ' mental wellbeing compared with a passive online information resource, at 20 weeks. There was a significant increase in mental health knowledge at 40 weeks in the intervention group. The trial was indicative of a small-to-moderate increase in wellbeing, quality of life, and positive caregiving experience, and a small reduction in negative caregiving experience and expressed emotion, at both 20 weeks and 40 weeks, but these changes were statistically non-significant. Effects on mental wellbeing at 20 weeks were greater in participants with higher use, although this finding was not significant. Study participant retention was high at 20 weeks and 40 weeks, with no adverse events or side-effects reported, indicating it is feasible to deliver psychoeducation safely via the internet.Implications of all the available evidenceOur study results suggest that a digital multicomponent psychoeducation intervention has no significant effect on carers ' mental wellbeing and quality of life, outcomes that have long been under-researched in the field of psychoeducation intervention effectiveness. In terms of caregiving-related outcomes that are more commonly reported in existing trials, such as caregiving experience and expressed emotion, our digital intervention was no more effective than was the control intervention. Our trial did not measure morbidities such as depression, anxiety or distress, or perceived burden, for which a positive effect has been identified in systematic reviews on conventional psychoeducation interventions delivered to family carers. Participant recruitment, retention, and completion in the trial were satisfactory. Notwithstanding the need for good evidence of clinical effectiveness and cost-effectiveness, the implication for policy is that digital psychoeducation intervention alone should not be commissioned for carers supporting an individual with psychosis with an expectation of a significant effect on mental wellbeing and other health outcomes. However, we note that participants ' usage of the digital intervention—in particular, posting on interactive forums—was highly heterogeneous and, overall, far below the recommended weekly login for half an hour. Considering the projected increase in the size of the carer population, it is not possible to meet these needs in primary care or specialist mental health services without using the potential digital technologies offer. Further research to optimise the potential of digital technologies in delivering effective support, possibly adjunctive to professional-led and face-to-face services, including strategies to optimise engagement and increase usage, remains important.
We did two systematic reviews at the outset of the trial in 2016, one focusing on psychoeducation interventions for family carers of individuals with psychosis or schizophrenia delivered using any medium, and the second focusing on interventions delivered via the internet. For both reviews, we searched ten databases that cover medical and health publications ( MEDLINE, PsycInfo, CINAHL, Embase, Web of Science, ASSIA, Cochrane Central Register of Controlled Trials, National Institute for Health Research—Health Technology Assessment database, Database of Abstracts of Reviews of Effect, and NHS Economic Evaluation Database) and grey literature ( ProQuest dissertations and theses) for studies published in English and Chinese from database inception to Dec 1, 2016. The search terms comprised subject headings, synonyms, and free-text search terms to identify ( digital/e- or m-/web or internet-) psychoeducation interventions for family/informal/unpaid carer * for people affected by schizophreni * or psycho *. Searches were limited to randomised controlled trials. Through both reviews, we identified 32 randomised trials, including 2858 family carers; only one trial that reported an entirely digital intervention with 21 carers ( and 31 patients) was identified. We did a meta-analysis, considering a range of mental health and caregiving-related outcomes. With relevance to this study, pooled results showed that psychoeducation, using a textual or face-to-face delivery format, was superior in reducing carers ' global morbidities ( standardised mean difference [ SMD ] –0·230), perceived burden ( SMD –0·434), negative caregiving experiences ( SMD –0·210), and expressed emotion ( SMD –0·161), compared with usual care. Effects on carers ' mental wellbeing were non-significant but data for this outcome were retrieved from just two trials and 184 participants. Only one trial investigated carers ' quality of life as an outcome. The search that focused on trials of digital interventions targeting family carers was updated on Dec 20, 2020, identifying an additional trial investigating a digital self-management intervention that was facilitated by carer peer workers, but carers ' mental wellbeing was not measured as an outcome. The search was updated on Aug 2, 2021, and the evidence base remains valid.
To our knowledge, this is the first fully randomised trial to report the clinical efficacy of a digital psychoeducation intervention that provides quality health information and network support from professionals and carers as peers. This trial provides clear evidence that a multi-component psychoeducation intervention delivered entirely online is not effective in improving carers ' mental wellbeing compared with a passive online information resource, at 20 weeks. There was a significant increase in mental health knowledge at 40 weeks in the intervention group. The trial was indicative of a small-to-moderate increase in wellbeing, quality of life, and positive caregiving experience, and a small reduction in negative caregiving experience and expressed emotion, at both 20 weeks and 40 weeks, but these changes were statistically non-significant. Effects on mental wellbeing at 20 weeks were greater in participants with higher use, although this finding was not significant. Study participant retention was high at 20 weeks and 40 weeks, with no adverse events or side-effects reported, indicating it is feasible to deliver psychoeducation safely via the internet.
Our study results suggest that a digital multicomponent psychoeducation intervention has no significant effect on carers ' mental wellbeing and quality of life, outcomes that have long been under-researched in the field of psychoeducation intervention effectiveness. In terms of caregiving-related outcomes that are more commonly reported in existing trials, such as caregiving experience and expressed emotion, our digital intervention was no more effective than was the control intervention. Our trial did not measure morbidities such as depression, anxiety or distress, or perceived burden, for which a positive effect has been identified in systematic reviews on conventional psychoeducation interventions delivered to family carers. Participant recruitment, retention, and completion in the trial were satisfactory. Notwithstanding the need for good evidence of clinical effectiveness and cost-effectiveness, the implication for policy is that digital psychoeducation intervention alone should not be commissioned for carers supporting an individual with psychosis with an expectation of a significant effect on mental wellbeing and other health outcomes. However, we note that participants ' usage of the digital intervention—in particular, posting on interactive forums—was highly heterogeneous and, overall, far below the recommended weekly login for half an hour. Considering the projected increase in the size of the carer population, it is not possible to meet these needs in primary care or specialist mental health services without using the potential digital technologies offer. Further research to optimise the potential of digital technologies in delivering effective support, possibly adjunctive to professional-led and face-to-face services, including strategies to optimise engagement and increase usage, remains important.
Clinical guidelines recommend psychoeducation to provide information on psychosis and its management for carers.1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar, 6HM GovernmentCarers at the heart of 21st-century families and communities. A caring system on your side, a life of your own. Department of Health, London2008Google Scholar, 7Galletly C Castle D Dark F et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.Aust N Z J Psychiatry. 2016; 50: 410-472Google Scholar Previous systematic reviews of clinical trials showed that psychoeducation that targeted carers as primary participants, with or without the patients ' presence or involvement in the intervention, reduced carers ' mental illness morbidities and caregiving burden.1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar, 2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar These changes mediate carers ' caregiving capacity,3Sin J Elkes J Batchelor R et al.Mental health and caregiving experiences of family carers supporting people with psychosis.Epidemiol Psychiatr Sci. 2021; 30: e3Google Scholar, 4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar, 7Galletly C Castle D Dark F et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.Aust N Z J Psychiatry. 2016; 50: 410-472Google Scholar, 8Cooper C Blanchard M Selwood A Walker Z Livingston G Family carers ' distress and abusive behaviour: longitudinal study.Br J Psychiatry. 2010; 196: 480-485Google Scholar translating to reduced relapse and better prognosis for patients.4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar, 7Galletly C Castle D Dark F et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.Aust N Z J Psychiatry. 2016; 50: 410-472Google Scholar However, implementation of such strategies is restricted2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 9Carers TrustAbout caring.https: //carers.org/about-caring/about-caringDate accessed: July 10, 2021Google Scholar because of insufficient resources in routine health services, and carers ' difficulties in attending sessions among multiple commitments.2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 9Carers TrustAbout caring.https: //carers.org/about-caring/about-caringDate accessed: July 10, 2021Google Scholar Although the internet offers a novel, accessible, and self-paced approach to deliver mental health interventions that addresses some of these barriers,10Powell J Hamborg T Stallard N et al.Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial.J Med Internet Res. 2012; 15: e2Google Scholar, 11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar, 12Powell J Deetjen U Characterizing the digital health citizen: mixed-methods study deriving a new typology.J Med Internet Res. 2019; 21e11279Google Scholar only one pilot study13Rotondi AJ Anderson CM Haas GL et al.Web-based psychoeducational intervention for persons with schizophrenia and their supporters: one-year outcomes.Psychiatr Serv. 2010; 61: 1099-1105Google Scholar and one definitive14Lobban F Akers N Appelbe D et al.Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar ( REACT): online, observer-blind, randomised controlled superiority trial.BMC Psychiatry. 2020; 20: 160Google Scholar randomised trial have evaluated such interventions in the field of psychosis caregiving to date.
Effective psychoeducation interventions for carers often comprise evidence-based health information and strategies to address commonly encountered challenges in psychosis caregiving, led by professionals and using a group format to enable exchanges of experiences and support among peers.4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar, 11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar Although most psychoeducation interventions tend to last for around 20 weeks, given their goals in imparting cognitive and behaviour changes in carers, previous meta-regression revealed no significant associations between intervention duration or contact time and outcomes.4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar We previously developed and tested the usability of an entirely web-based multicomponent intervention called COPe-support.15Sin J Henderson C Woodham LA Sesé Hernández A Gillard S A multicomponent eHealth intervention for family carers for people affected by psychosis: a coproduced design and build study.J Med Internet Res. 2019; 21e14374Google Scholar, 16Sin J Woodham LA Henderson C Williams E Sesé Hernández A Gillard S Usability evaluation of an eHealth intervention for family carers of individuals affected by psychosis: a mixed-method study.Digit Health. 2019; 5 ( 2055207619871148) Google Scholar This study examined whether COPe-support improved carers ' mental wellbeing and health-related and caregiving-related outcomes, compared with a passive online information resource as control.
In this randomised trial, we used a two-arm, individually randomised, superiority design that compared COPe-support with a passive online information resource. We did an internal pilot trial to test the trial procedures, recruitment, and retention, that ran for the first 12 months of the 30-month trial duration. The pilot stop–go criteria were: to recruit at least a third of the sample size and to retain at least 80% of participants, with over 80% of them having activated their logins. A detailed trial protocol has been previously published.17Sin J Henderson C Cornelius V et al.COPe-support—a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial.BMC Psychiatry. 2020; 20: 129Google Scholar This study has been reviewed and approved by South Central—Oxford C Research Ethics Committee ( reference 18/SC/0104) and the UK National Health Service ( NHS) Health Research Authority ( reference IRAS 240005). Substantial patient, carer, and public involvement activities underpinned the design and conduct of the study. We have eight patient, carer, and key stakeholder members among our 14-membered Project Reference Group, which oversaw the study design, identified the outcomes and measures used in the study, and supported the study delivery, data analysis, and dissemination of the study results.15Sin J Henderson C Woodham LA Sesé Hernández A Gillard S A multicomponent eHealth intervention for family carers for people affected by psychosis: a coproduced design and build study.J Med Internet Res. 2019; 21e14374Google Scholar
The trial included relatives and close friends aged 18 years or older who provided at least weekly support in any format for the cared-for person who had psychosis,1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar had daily access to the internet including emails, and were able to communicate in English. Both the carers and the cared-for person were required to reside in England during the study period. To avoid a clustering effect, potential participants who had another relative or friend who shared the caring role for the same cared-for person already enrolled in the study were excluded.
Participants were recruited through 30 mental health NHS trusts ( provider organisations) across England. We advertised through flyers and posters, asking health-care workers to inform potentially eligible carers, national and local voluntary organisations that provide support for carers, our study website, and social media communications with relevant organisations.
Potentially suitable participants completed an online eligibility screening process through our research website. Queries were resolved and further information provided through phone or online discussion with the study coordinator. Those eligible provided online written informed consent.
We used an independent online system to randomly assign participants ( 1:1), stratified by gender ( male vs female) and recruitment cohort ( cohort 1 to 6), to either COPe-support or a passive online information resource. We used a permuted block randomisation scheme that included randomly selected sized blocks of two and four. Over the study duration, we scheduled participants into six cohorts, placed 4 months apart to ensure optimal numbers ( ie, ≥20 but ≤60 of participants in each arm).4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar Randomisation was done in order of baseline data collection in the 4 months recruitment time prior to each cohort starting. The study team were masked to allocation and assessment of outcomes as all data collection took place online. It was not feasible to mask participants or the online facilitator to intervention allocation. Statistical analyses were done masked to allocation.
Participants received an email that provided unique login details to access the allocated intervention, together with instructions to download the free app ( Apple or Android), which enabled use through smart phones or tablets, in addition to computers via web browsers. Participants had access to either condition for 40 weeks and were advised to spend at least half an hour per week over the initial 20 weeks to go through materials at their own pace and to allow time to integrate knowledge and skills learned into practice. An experienced mental health nurse ( JSi) acted as the online facilitator who monitored and moderated all the interactive functions. The online facilitator sent weekly updates via the intervention announcement function, which generated an email automatically to participants to promote engagement. For security and anonymity, participants were required to follow ground rules, including the use of a self-chosen pseudonym and to not give any of their or their cared-for person's identifiable details on the platform.15Sin J Henderson C Woodham LA Sesé Hernández A Gillard S A multicomponent eHealth intervention for family carers for people affected by psychosis: a coproduced design and build study.J Med Internet Res. 2019; 21e14374Google Scholar, 16Sin J Woodham LA Henderson C Williams E Sesé Hernández A Gillard S Usability evaluation of an eHealth intervention for family carers of individuals affected by psychosis: a mixed-method study.Digit Health. 2019; 5 ( 2055207619871148) Google Scholar
COPe-support was codesigned and coproduced with people with lived experiences of psychosis or caring experience, and key stakeholders working in the field, through a participatory research study.15Sin J Henderson C Woodham LA Sesé Hernández A Gillard S A multicomponent eHealth intervention for family carers for people affected by psychosis: a coproduced design and build study.J Med Internet Res. 2019; 21e14374Google Scholar Our considerations of the intervention content and key ingredients, duration and intensity ( ie, 20 weeks), and facilitation strategies ( eg, moderation and anonymous participation) had also been informed by our theoretical development work.4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar During the intervention-build process, 24 carers independent from the study reviewed and gave feedback on the early versions of the prototype.15Sin J Henderson C Woodham LA Sesé Hernández A Gillard S A multicomponent eHealth intervention for family carers for people affected by psychosis: a coproduced design and build study.J Med Internet Res. 2019; 21e14374Google Scholar A mixed methods usability study incorporating a think-aloud test and remote usability test was done with 20 carers over 3 months, from Nov 1, 2017, to Jan 31, 2018, to establish the feasibility of delivering COPe-support via the internet ( appendix pp 13–14).16Sin J Woodham LA Henderson C Williams E Sesé Hernández A Gillard S Usability evaluation of an eHealth intervention for family carers of individuals affected by psychosis: a mixed-method study.Digit Health. 2019; 5 ( 2055207619871148) Google Scholar
COPe-support was a multimedia, interactive intervention that provided psychoeducation and network support with peers and professionals, delivered through the web-based learning environment Canvas. In addition to a home page, which provided a menu, navigation video, and guide, the intervention comprised 12 sections. These included psychoeducation on psychosis, its treatment, and related caring issues; wellbeing promotion information and exercises; an ask the experts online forum, where participants could ask for advice from 14 experts, including multidisciplinary clinicians, welfare benefits advisors, and people using mental health services; a peer-to-peer forum, where participants could exchange views and support; a resources for carers section that provided extensive links to relevant external resources ( eg, statutory and professional bodies, charities, books, and online information sites); and a support weblink, for participants to seek technical or emotional support if necessary. There was no prescribed order or sequence on the content; instead, participants were encouraged to pick the content specific to their own needs and caring situations. Participants were able to initiate posts and respond to both ask the experts and peer-to-peer forums or visit both forums passively ( ie, reading posts).
A web-based information resource run on a parallel Canvas platform acted as the control, which had an identical presentation and format to the COPe-support platform. The control platform comprised a home page, support function, and all the information provided under resources for carers in the COPe-support platform. There were no interactive elements included in the passive online information resource platform, similar to other information websites as the most common provision within wider usual care. To optimise retention, control group participants were given access to COPe-support for 20 weeks, after completing 40-week follow-up data collection.
All participants had unrestricted access to usual care, which commonly comprised information and advice sought from primary care or NHS mental health service or voluntary organisations. As usual care for carers varies geographically and based on participants ' circumstances, we collected health, social, voluntary, and other service use data from participants.
To assess mental wellbeing, we used the Warwick-Edinburgh Mental Wellbeing Scale ( WEMWBS).18Tennant R Hiller L Fishwick R et al.The Warwick-Edinburgh Mental Well-being Scale ( WEMWBS): development and UK validation.Health Qual Life Outcomes. 2007; 5: 63Google Scholar The WEMWBS has been widely used to measure positive mental health at the population level; 19Maheswaran H Weich S Powell J Stewart-Brown S Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale ( WEMWBS): group and individual level analysis.Health Qual Life Outcomes. 2012; 10: 156Google Scholar its scores range from 14–70 with higher scores indicating better wellbeing,18Tennant R Hiller L Fishwick R et al.The Warwick-Edinburgh Mental Well-being Scale ( WEMWBS): development and UK validation.Health Qual Life Outcomes. 2007; 5: 63Google Scholar and a change of 3 points represents the minimally clinically important difference ( MCID).19Maheswaran H Weich S Powell J Stewart-Brown S Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale ( WEMWBS): group and individual level analysis.Health Qual Life Outcomes. 2012; 10: 156Google Scholar Quality of life was measured using the EQ-5D-5L visual analogue scale ( VAS), on which higher scores represent better subjective judgement of health state.20Szende A Janssen B Cabases J Self-reported population health: an international perspective based on EQ-5D. Springer, Dordrecht2014Google Scholar Mental health knowledge was measured using the Mental Health Knowledge Schedule ( MAKS); higher scores indicate better stigma-related mental health knowledge.21Evans-Lacko S Little K Meltzer H et al.Development and psychometric properties of the Mental Health Knowledge Schedule.Can J Psychiatry. 2010; 55: 440-448Google Scholar Appraisal of caregiving experience was measured using the Experience of Caregiving Inventory ( ECI), which has positive subscales for which higher scores indicate better experience, and negative subscales with higher scores indicating poorer experience.22Szmukler GI Burgess P Herrman H Benson A Colusa S Bloch S Caring for relatives with serious mental illness: the development of the Experience of Caregiving Inventory.Soc Psychiatry Psychiatr Epidemiol. 1996; 31: 137-148Google Scholar Carers ' wellbeing and satisfaction with support was measured using the Carer Wellbeing and Support Scale ( CWS); higher wellbeing subscale scores indicate higher wellbeing, and higher support subscale scores with reversed scoring indicate worse satisfaction.23Quirk A Smith S Hamilton S et al.The development and validation of the Carer Well-Being and Support ( CWS) Questionnaire.Ment Health Rev ( Brighton). 2012; 17: 128-138Google Scholar Carers ' expressed emotion in terms of criticism and over-involvement was measured with the Family Questionnaire ( FQ), on which higher scores indicate higher expressed emotion.24Wiedemann G Rayki O Feinstein E Hahlweg K The Family Questionnaire: development and validation of a new self-report scale for assessing expressed emotion.Psychiatry Res. 2002; 109: 265-279Google Scholar
Study outcomes were assessed at baseline, mid-treatment ( 10 weeks), 20-week follow-up ( primary endpoint), and 40-week follow-up. All primary and secondary outcomes were self-report measures completed by participants online. At baseline, participants were asked to provide demographic data and information on their caregiving situation, such as time spent caregiving per week, relationship with the cared-for person, and minimal, non-identifiable information about the cared-for person, comprising age, gender, specific psychotic disorder type, and time since illness onset.17Sin J Henderson C Cornelius V et al.COPe-support—a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial.BMC Psychiatry. 2020; 20: 129Google Scholar
We prespecified use data at 20 weeks to be automatically recorded by the online platform,17Sin J Henderson C Cornelius V et al.COPe-support—a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial.BMC Psychiatry. 2020; 20: 129Google Scholar including number of logins in separate weeks, weekly and total page views over 20 weeks, total time spent on the platform in min, and mean time spent per page view, for both groups. For the COPe-support group, the numbers of posts per participant made to each forum were recorded. These measures are the most recorded digital health intervention use metrics reported in similar studies.10Powell J Hamborg T Stallard N et al.Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial.J Med Internet Res. 2012; 15: e2Google Scholar, 11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar, 12Powell J Deetjen U Characterizing the digital health citizen: mixed-methods study deriving a new typology.J Med Internet Res. 2019; 21e11279Google Scholar, 13Rotondi AJ Anderson CM Haas GL et al.Web-based psychoeducational intervention for persons with schizophrenia and their supporters: one-year outcomes.Psychiatr Serv. 2010; 61: 1099-1105Google Scholar, 14Lobban F Akers N Appelbe D et al.Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar ( REACT): online, observer-blind, randomised controlled superiority trial.BMC Psychiatry. 2020; 20: 160Google Scholar
The perceived acceptability of COPe-support was obtained through individual interviews after 40 weeks of follow-up with 20% of the intervention participants. These data have been reported separately.25Batchelor R Gulshan S Shritharan H et al.Perceived acceptability and experiences of a digital psychoeducation and peer support intervention ( COPe-support): interview study with carers supporting individuals with psychosis.J Med Internet Res. 2022; 24e27781Google Scholar
The primary outcome was mental wellbeing at 20 weeks, assessed by the WEMWBS.18Tennant R Hiller L Fishwick R et al.The Warwick-Edinburgh Mental Well-being Scale ( WEMWBS): development and UK validation.Health Qual Life Outcomes. 2007; 5: 63Google Scholar
Secondary outcomes at 20-weeks were: quality of life, mental health knowledge, appraisal of caregiving experience, carer wellbeing and satisfaction with support, and carers ' expressed emotion in terms of criticism and over-involvement.
For safety monitoring, in addition to adverse events and serious adverse events, we devised a category labelled unintended consequences, to denote incidents of access interruptions to the interventions. All safety events were documented, categorised, and evaluated by an independent Trial Steering Committee ( appendix pp 23–24).17Sin J Henderson C Cornelius V et al.COPe-support—a multi-component digital intervention for family carers for people affected by psychosis: study protocol for a randomized controlled trial.BMC Psychiatry. 2020; 20: 129Google Scholar
To detect an MCID of 3 points for the between-group difference in WEMWBS score,20Szende A Janssen B Cabases J Self-reported population health: an international perspective based on EQ-5D. Springer, Dordrecht2014Google Scholar assuming a SD of 9,26Sin J Murrells T Spain D Norman I Henderson C Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: an exploratory study.Soc Psychiatry Psychiatr Epidemiol. 2016; 51: 1247-1255Google Scholar a sample size of 360 participants was required with α=0·05 ( two-tailed) at 80% power, accounting for 20% dropout.
Our primary estimand was the effect of COPe-support for all participants regardless of use ( treatment policy estimand),27International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human UseICH Harmonised Guideline. Addendum on estimands and sensitivity analysis in clinical trials to the guideline on statistical principles for clinical trials.https: //database.ich.org/sites/default/files/E9-R1 Step4 Guideline 2019 1203.pdfDate: Nov 20, 2019Date accessed: July 10, 2021Google Scholar including participants with at least one post-baseline assessment in their allocated groups ( intention-to-treat principle). We used a linear mixed model to estimate the mean difference in WEMWBS score between arms at 20 weeks. The model included baseline score, three indicators for each timepoint ( 10 weeks, 20 weeks, and 40 weeks), an indicator for intervention allocated, a timepoint and intervention interaction, gender ( stratification variable), parent ( yes vs no), and living with the cared-for individual ( yes vs no) as fixed effects, with cohort and participant as random effects. The model was fitted using restricted maximum likelihood and assumptions were checked through residual plots. A further analysis estimated the intervention effect for the subsample of intervention compliers ( intervention efficacy estimand). We predefined compliers as participants in the COPe-support group who made at least two logins in separate weeks by week 20 ( ie, those who had chosen to return to the intervention after their initial successful login activation). We performed a complier average causal effect ( CACE) analysis28Dunn G Maracy M Dowrick C et al.Estimating psychological treatment effects from a randomised controlled trial with both non-compliance and loss to follow-up.Br J Psychiatry. 2003; 183: 323-331Google Scholar using a two-stage least squares regression with randomisation as the instrumental variable. We also did a post-hoc CACE analysis to assess intervention effects of different use thresholds as alternative complier definitions.
We did a sensitivity analysis to explore the effect of missing data and departures from the missing-at-random ( MAR) assumption on the primary estimand, using controlled multiple imputation. Imputations were done separately within each intervention arm using variables in the primary model and auxiliary variables identified as strongly associated in previous work.3Sin J Elkes J Batchelor R et al.Mental health and caregiving experiences of family carers supporting people with psychosis.Epidemiol Psychiatr Sci. 2021; 30: e3Google Scholar A further sensitivity analysis was also done using multiple imputation across every timepoint to include all participants.
The intervention difference for all secondary outcome measures was estimated as the treatment policy estimand, using linear regression models including intervention arm, baseline score, gender, and cohort. The analysis was done separately at each timepoint ( 10 weeks, 20 weeks, and 40 weeks), with the primary focus at 20 weeks. Incidents of adverse events, serious adverse events, and unexpected consequences were tabulated showing number of events and number of participants per arm.
Analyses were done with Stata version 15. The trial was registered prospectively with ISRCTN, ISRCTN89563420.
The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Between March 1, 2018, and Feb 14, 2020 ( the study recruitment period), there were 695 visits to the online study enrolment platform. 527 people undertook eligibility screening, with 465 confirmed as eligible for the study ( figure 1). 189 of the participants were recruited into the internal pilot. Criteria for the internal pilot were met and the trial steering committee approved the trial to progress. 407 participants completed baseline assessment and were randomly assigned, with 204 allocated to COPe-support and 203 allocated to control. The last participant completed their final visit on Oct 31, 2020. Four ( 2%) of 204 participants withdrew from the intervention group and six ( 3%) of 203 participants withdrew from the control group.Figure 1Trial profileShow full captionA participant who missed a visit did not provide any data at the given timepoint; a participant who attended a visit was not required to have completed all outcome data. The number of participants included in the primary analysis were those with at least one post-baseline assessment in their allocated groups.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
A participant who missed a visit did not provide any data at the given timepoint; a participant who attended a visit was not required to have completed all outcome data. The number of participants included in the primary analysis were those with at least one post-baseline assessment in their allocated groups.
Baseline characteristics were similar between the two study groups ( table 1). The mean participant age was 53·1 years ( SD 13·2), 330 ( 81%) of 407 participants were women, 258 ( 63%) were parents, 359 ( 88%) were White, and 197 ( 49%) had been caring for less than 5 years. Participants were recruited from all regions of NHS mental health services in England ( North East, North West, South East, South West of England, Yorkshire, Midlands, and East England). During the first 20 weeks of the study, 355 ( 87%) of 407 participants activated their logins—175 ( 86%) of 204 participants in the intervention group and 180 ( 89%) of 203 participants in the control group. The COPe-support group logged in a median of 4·0 times ( IQR 2·0–7·0), with a median usage time of 69·7 min ( 17·3–176·1). Control participants logged in a median of 2·0 times ( 1·0–4·0), with a median usage time of 20·4 min ( 9·1–38·8; appendix p 63).Table 1Demographic and caregiving characteristics of study participants at baselineCOPe-support ( n=204) Control ( n=203) Age, years53·7 ( 13·3) 52·5 ( 13·1) GenderMale39 ( 19%) 38 ( 19%) Female165 ( 81%) 165 ( 81%) RaceWhite178 ( 87%) 181 ( 89%) Mixed7 ( 4%) 8 ( 4%) Asian10 ( 5%) 6 ( 3%) Black8 ( 4%) 6 ( 3%) Other1 ( < 1%) 2 ( 1%) Employment statusFull time68 ( 33%) 63 ( 31%) Part time40 ( 20%) 43 ( 21%) Full or part-time education6 ( 3%) 4 ( 2%) Unemployed5 ( 2%) 3 ( 1%) Permanently disabled or sick6 ( 3%) 11 ( 5%) Retired50 ( 25%) 45 ( 22%) Looking after family or home25 ( 12%) 27 ( 13%) Other4 ( 2%) 7 ( 3%) Highest education level achievedSecondary50 ( 25%) 49 ( 24%) A level11 ( 5%) 17 ( 8%) University67 ( 33%) 65 ( 32%) Post-graduate54 ( 26%) 33 ( 16%) Apprenticeship16 ( 8%) 24 ( 12%) Professional qualification6 ( 3%) 15 ( 7%) Marital statusSingle40 ( 20%) 41 ( 20%) Married or cohabiting140 ( 69%) 138 ( 68%) Divorced23 ( 11%) 22 ( 11%) Other1 ( < 1%) 2 ( 1%) Relationship with cared-for personParent129 ( 63%) 129 ( 64%) Spouse or partner46 ( 23%) 41 ( 20%) Child9 ( 4%) 12 ( 6%) Sibling11 ( 5%) 12 ( 6%) Other relative01 ( < 1%) Friend9 ( 4%) 8 ( 4%) Living arrangementWith cared-for person111 ( 54%) 116 ( 57%) Not with cared-for person93 ( 46%) 87 ( 43%) Duration of care, h per week1–960 ( 29%) 50 ( 25%) 10–1944 ( 22%) 33 ( 16%) 20–3423 ( 11%) 34 ( 17%) 35–4915 ( 7%) 26 ( 13%) ≥5062 ( 30%) 60 ( 30%) Age of cared-for person, years35·5 ( 14·2) 34·5 ( 13·7) Sex of cared-for personFemale72 ( 35%) 80 ( 39%) Male132 ( 65%) 123 ( 61%) Time since cared-for person's illness onset, years0–5102 ( 50%) 95 ( 47%) ≥5–1026 ( 13%) 38 ( 19%) > 1076 ( 37%) 70 ( 34%) Data are mean ( SD) or n (%). Open table in a new tab
The primary analysis included 174 ( 85%) of 204 participants in the COPe-support group and 172 ( 85%) of 203 participants in the control group ( participants with at least one post-baseline assessment in their allocated groups). The mean WEMWBS score at 20 weeks was 44·5 ( SD 8·31) in the COPe-support group and 43·3 ( 9·19) in the control group ( figure 2). The adjusted between-arm mean difference in WEMWBS score was 0·37 ( 95% CI –1·14 to 1·88; p=0·63; table 2). A sensitivity analysis to explore the effect of missing data resulted in an estimated between-group range in WEMWBS score from 0·09 to 0·75 at 20 weeks ( appendix p 64). A further supplementary analysis including all participants randomly assigned, showed a between-arm difference in WEBWMS score of 0·24 ( 95% CI –1·43 to 1·91) at 20 weeks. This additional analysis was consistent with our original conclusions.Figure 2Unadjusted mean WEMWBS score across the four timepoints by treatment armShow full captionError bars indicate 95% CIs. The vertical dotted line indicates the start of the additional follow-up period. WEMWBS=Warwick-Edinburgh Mental Wellbeing Scale.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) Table 2Analysis of primary and secondary efficacy outcomes at 20 weeksCOPe-supportAttention controlAdjusted treatment difference ( 95% CI) p valuenMean ( SD) nMean ( SD) Primary outcomeWarwick-Edinburgh Mental Wellbeing Scale15644·5 ( 8·31) 15143·3 ( 9·19) 0·37 ( −1·14 to 1·88) 0·63Secondary outcomesMental Health Knowledge Schedule15624·1 ( 2·56) 15123·7 ( 2·86) 0·39 ( −0·14 to 0·91).. ECI negative15596·6 ( 35·50) 148100·5 ( 34·61) −3·39 ( −8·26 to 1·49).. ECI positive15530·2 ( 7·76) 14829·8 ( 7·68) 0·38 ( −0·96 to 1·72).. EQ-5D 5-level visual analogue scale15470·2 ( 17·08) 14769·0 ( 21·22) 0·52 ( −2·79 to 3·83).. Family Questionnaire15448·6 ( 10·66) 14749·0 ( 10·78) −0·20 ( −1·80 to 1·39).. CWS-support15420·1 ( 11·33) 14821·2 ( 11·39) −1·04 ( −3·09 to 1·02).. CWS-wellbeing15480·7 ( 28·24) 14878·8 ( 28·36) −0·91 ( −5·29 to 3·46).. ECI=Experience of Caregiving Inventory. CWS=Carer Wellbeing and Support Scale Open table in a new tab
Error bars indicate 95% CIs. The vertical dotted line indicates the start of the additional follow-up period. WEMWBS=Warwick-Edinburgh Mental Wellbeing Scale.
ECI=Experience of Caregiving Inventory. CWS=Carer Wellbeing and Support Scale
The adjusted mean difference between the study groups at 10 weeks was 1·05 ( 95% CI –0·43 to 2·53; p=0·17). At 40-week follow-up, the adjusted between-arm mean difference was 0·37 ( 95% CI –1·16 to 1·89; p=0·64; table 3).Table 3Analysis for primary and secondary efficacy outcomes at 10 weeks and 40 weeks follow-upCOPe-supportAttention controlAdjusted treatment difference ( 95% CI) p valuenMean ( SD) nMean ( SD) Primary outcomeWarwick-Edinburgh Mental Wellbeing ScaleWeek 1016144·6 ( 8·77) 16143·2 ( 9·34) 1·05 ( −0·43 to 2·53) 0·17Week 4014944·7 ( 9·41) 14944·1 ( 9·86) 0·37 ( −1·16 to 1·89) 0·64Secondary outcomesMental Health Knowledge ScheduleWeek 1016123·8 ( 2·90) 16123·8 ( 2·92) 0·00 ( −0·54 to 0·54).. Week 4014924·0 ( 2·93) 14823·4 ( 3·00) 0·64 ( 0·11 to 1·18).. ECI negativeWeek 10160103·0 ( 34·56) 159102·2 ( 32·27) −0·46 ( −4·64 to 3·71).. Week 4014999·3 ( 37·62) 14798·0 ( 36·10) 0·71 ( −4·73 to 6·14).. ECI positiveWeek 1016030·5 ( 8·21) 15929·7 ( 7·16) 0·49 ( −0·78 to 1·76).. Week 4014929·8 ( 7·57) 14729·8 ( 7·74) −0·20 ( −1·56 to 1·16).. EQ-5D 5-level visual analogue scaleWeek 1016070·7 ( 17·16) 15768·9 ( 19·79) 1·03 ( −1·71 to 3·77).. Week 4014968·6 ( 18·76) 14669·7 ( 18·01) −0·93 ( −4·21 to 2·35).. Family QuestionnaireWeek 1016049·5 ( 10·26) 15749·3 ( 10·12) −0·04 ( −1·45 to 1·38).. Week 4014949·0 ( 10·12) 14748·3 ( 11·16) 0·42 ( −1·29 to 2·13).. CWS-supportWeek 1016020·4 ( 11·29) 15720·7 ( 11·24) −0·15 ( −2·00 to 1·69).. Week 4014920·5 ( 12·07) 14720·4 ( 11·66) −0·18 ( −2·35 to 1·98).. CWS-wellbeingWeek 1016078·3 ( 28·17) 15876·8 ( 26·98) −0·93 ( −4·85 to 2·98).. Week 4014978·7 ( 28·52) 14779·0 ( 29·32) −2·13 ( −6·84 to 2·59).. ECI=Experience of Caregiving Inventory. CWS=Carer Wellbeing and Support Scale. Open table in a new tab
ECI=Experience of Caregiving Inventory. CWS=Carer Wellbeing and Support Scale.
The primary CACE analysis included 156 ( 76%) of 204 participants in the intervention group and 151 ( 74%) of 203 participants in the control group ( participants who provided WEMWBS score data at 20 weeks). In the intervention group, 106 ( 52%) of 204 participants met the prespecified complier definition ( ie, ≥2 weekly logins). The mean WEMWBS score for these participants at 20 weeks was 44·9, compared with 42·9 for the would-be compliers in the control group. The adjusted between-arm difference in WEMWBS score was 0·83 ( 95% CI –1·45 to 3·11; p=0·47), showing no evidence of a statistical difference between the study groups. The efficacy estimate was greater than the treatment policy estimand in favour of COPe-support, but not close to the MCID of 3. Post-hoc analyses using different complier definitions resulted in an estimated range of between-arm difference from 0·87 to 1·45, and the difference was greatest in those who had spent over 120 min on the COPe-support platform by 20 weeks ( table 4). This additional analysis was consistent with our original conclusions.Table 4Complier average causal effect analysis for Warwick-Edinburgh Mental Wellbeing Scale score for different complier definitionsNumber of participants * Number of COPe-support participants who met the complier definition.Adjusted treatment estimate ( 95% CI) Weekly logins ≥2 ( original) 960·83 ( −1·45 to 3·11) Weekly logins ≥2 and post ≥1571·38 ( −2·40 to 5·16) Total activity > 60 min830·96 ( −1·66 to 3·59) Total activity > 120 min551·45 ( −2·52 to 5·42) Page views > 100920·87 ( −1·50 to 3·24) * Number of COPe-support participants who met the complier definition. Open table in a new tab
Results from the analysis of our secondary outcomes were similar to the results for the primary outcome ( table 2). The adjusted 20-week between-arm difference was small for all secondary outcomes and there was no evidence of a significant difference. The point estimates for six of the measures we investigated were in favour of the COPe-support arm ( MAKS, ECI positive and negative subscales, EQ-5D-5L VAS, FQ, and CWS-support) and one measure ( CWS-wellbeing) was in favour of the control. At 40-week follow-up, similar results for all secondary outcomes, apart from mental health knowledge, were found; the intervention group had significantly higher MAKS ( 0·64; 95% CI 0·11–1·18; p=0·018) compared with the control group ( table 3).
No adverse events or serious adverse events were reported. There were 21 unintended consequences reported by 20 participants: ten in the intervention group and 11 ( by ten participants) in the control group. All unintended consequences were related to problems in activating logins or accessing the interventions.
In this study, among carers supporting an individual with psychosis, using COPe-support to provide web-based interactive psychoeducation and network support for 20 weeks did not significantly improve mental wellbeing compared with a passive online information resource. Similar results were found for all secondary outcomes at 20 weeks and 40 weeks, with the exception of stigma-related mental health knowledge, which reflected a more positive outlook on treatment effectiveness and on recovery. Although mental wellbeing and a range of caregiving-related and mental health outcomes improved among COPe-support participants, COPe-support was not superior to the control intervention.
Our trial results echoed those of a study of an online self-management intervention facilitated by trained peer workers for carers of people with psychosis in England.14Lobban F Akers N Appelbe D et al.Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar ( REACT): online, observer-blind, randomised controlled superiority trial.BMC Psychiatry. 2020; 20: 160Google Scholar We propose several potential explanations for the results. First, overall use of COPe-support was below our recommended weekly 30 mins of use for 20 weeks; we did anticipate participants ' use would be heterogeneous and less than regular, depending on needs. Heterogeneous use and adherence has been frequently observed in digital mental health interventions, in particular in self-guided ones.10Powell J Hamborg T Stallard N et al.Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial.J Med Internet Res. 2012; 15: e2Google Scholar, 11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar, 12Powell J Deetjen U Characterizing the digital health citizen: mixed-methods study deriving a new typology.J Med Internet Res. 2019; 21e11279Google Scholar, 13Rotondi AJ Anderson CM Haas GL et al.Web-based psychoeducational intervention for persons with schizophrenia and their supporters: one-year outcomes.Psychiatr Serv. 2010; 61: 1099-1105Google Scholar, 14Lobban F Akers N Appelbe D et al.Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar ( REACT): online, observer-blind, randomised controlled superiority trial.BMC Psychiatry. 2020; 20: 160Google Scholar, 29Murray E Hekler EB Andersson G et al.Evaluating digital health interventions: key questions and approaches.Am J Prev Med. 2016; 51: 843-851Google Scholar Although face-to-face psychosocial interventions commonly have in-built engagement sessions that have been shown to mediate therapeutic alliance, adherence, and effects,4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar, 30Flückiger C Del Re AC Wampold BE Symonds D Horvath AO How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis.J Couns Psychol. 2012; 59: 10-17Google Scholar online interventions such as COPe-support might fall short in engagement with participants, relying solely on online communciations, and therefore hampering ongoing content delivery.10Powell J Hamborg T Stallard N et al.Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: randomized controlled trial.J Med Internet Res. 2012; 15: e2Google Scholar, 11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar, 12Powell J Deetjen U Characterizing the digital health citizen: mixed-methods study deriving a new typology.J Med Internet Res. 2019; 21e11279Google Scholar, 29Murray E Hekler EB Andersson G et al.Evaluating digital health interventions: key questions and approaches.Am J Prev Med. 2016; 51: 843-851Google Scholar Our CACE analysis showed a greater effect in participants with higher use, but this difference was not significant. This finding raises the possibility that the absence of a significant effect could have been partly because of low or no minimally sufficient treatment dosage. However, there is insufficient research to indicate the required compliance threshold.11Sin J Henderson C Spain D Cornelius V Chen T Gillard S eHealth interventions for family carers of people with long term illness: a promising approach?.Clin Psychol Rev. 2018; 60: 109-125Google Scholar, 29Murray E Hekler EB Andersson G et al.Evaluating digital health interventions: key questions and approaches.Am J Prev Med. 2016; 51: 843-851Google Scholar Second, although the effectiveness of face-to-face psychoeducational interventions in reducing psychological distress and burden is well established,4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar the pathways to positive effects on carer mental health remain unclear. Third, although participants reported feeling better supported through COPe-support, it is possible that they did not observe clinical improvement in the people they were caring for; therefore, their own outcomes did not change. Almost all the participants were recruited through mental health services, indicating that the carers were supporting an individual receiving care at the time of the study. This fact might imply that participants ' need for support was high and beyond what COPe-support was designed for. Fourth, participants across groups had access to health information resources and usual care, potentially contributing to a larger control group effect. Previous conventional psychoeducational intervention trials commonly used waitlists or usual care as a comparator and so a tougher test of effect was applied in this study.4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar
The strengths of this study were its large sample size, broad inclusion criteria that considered the varied nature of caregiving in psychosis ( such as different relationships between carers and cared-for people and time spent on caregiving), a web-based active control group to reduce confounding factors inherent in technology or delivery medium, and use of methods designed to reduce the risk of bias, such as participant-reported outcome measures, statistical analysis done masked to allocation, intention-to-treat analyses, and a pre-registered statistical analysis plan. Our study did have some limitations. Our results might be more generalisable to individuals who are similar to the study sample, most of whom were women, White, and used internet communications regularly. We recruited carers as participants across England where, although health services share the same systems and clinical guidelines,1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar variation in care and resources available for carers across areas does exist. Although the random assignment should have removed any allocation bias, we did not prespecify the areas in which carers or their cared-for people resided as a stratification factor. Similar to many other psychotherapy trials, participant masking was not possible, which might have led to bias by expectation, considering that all outcomes were self-reported.
Psychoeducation, delivered as a group programme that facilitates exchanges of experiential knowledge and support between peers, is among the most effective interventions recommended for carers supporting an individual with psychosis.1National Institute for Clinical ExcellencePsychosis and schizophrenia in adults: treatment and management ( National Clinical Guideline no 178). National Collaboration Centre for Mental Health, London2014Google Scholar, 2The Schizophrenia CommissionThe abandoned illness–a report by the Schizophrenia Commission. Rethink Mental Illness, London2012Google Scholar, 4Sin J Gillard S Spain D Cornelius V Chen T Henderson C Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis.Clin Psychol Rev. 2017; 56: 13-24Google Scholar, 5Yesufu-Udechuku A Harrison B Mayo-Wilson E et al.Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis.Br J Psychiatry. 2015; 206: 268-274Google Scholar, 7Galletly C Castle D Dark F et al.Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.Aust N Z J Psychiatry. 2016; 50: 410-472Google Scholar Paradoxically, implementation of such interventions is limited. Self-guided digital interventions, such as COPe-support, offer full user autonomy and require minimal input from health-care professionals. A high proportion of carers remained engaged with the intervention for 40 weeks, with no adverse events reported over the 30-month study duration. These findings suggest that digital technology can be used effectively to meet carers ' needs for psychoeducation and network support across a vast geographical area. Our study findings on improved stigma-related mental health knowledge among carers suggest that COPe-support might have had benefits in relation to knowledge rather than in relation to wellbeing and health; we will explore this hypothesis further in the qualitative analysis of participant interviews. Further research is also needed to explore the effects of peer workers or peer researchers instead of clinicians acting as online forum facilitators or study coordinators, in both usage of and nature of interactions. COPe-support, adapted with better digital engagement strategies that promote higher use and as an adjunct to some face-to-face support from local services, might have the potential to fill an important gap in delivering high-quality psychoeducation to carers. Considering the strong association between carers ' own wellbeing and their caring capacity, which inevitably affect the recovery of the person they care for,3Sin J Elkes J Batchelor R et al.Mental health and caregiving experiences of family carers supporting people with psychosis.Epidemiol Psychiatr Sci. 2021; 30: e3Google Scholar, 8Cooper C Blanchard M Selwood A Walker Z Livingston G Family carers ' distress and abusive behaviour: longitudinal study.Br J Psychiatry. 2010; 196: 480-485Google Scholar, 9Carers TrustAbout caring.https: //carers.org/about-caring/about-caringDate accessed: July 10, 2021Google Scholar interventions targeting carers, as both users and providers of care, can have far-reaching effects. Furthermore, with the implementation of digital interventions, accelerated in light of the COVID-19 pandemic to overcome face-to-face contact restrictions, further research is warranted to investigate strategies to optimise use and effects of carer-focused digital interventions. With the projected increase in the carer population, many of whom are unable to attend or have no access to in-person interventions, it is not possible to meet these needs in primary care or specialist mental health services without exploiting the potential of digital technologies.
In conclusion, our results show that for carers supporting an individual with psychosis, COPe-support providing online psychoeducation and support from professionals and peers was not superior to a high-quality passive information resource in improving mental wellbeing at 20 weeks. Our findings do not support the use of COPe-support in its current format rather than a passive online information resource. Considering the projected increase in the carer population and demand for support, delivering evidence-based interventions via the internet adjunctive to face-to-face services remains a potentially viable option.
JSi led the study at all stages with guidance from CH, VC, and SG. CH, JE, VC, LAW, TC, and SG helped design the study. JSi wrote the trial protocol with input from CH, SG, VC, LAW, and TC. VC, TC, JE, and JSi designed and wrote the statistical analysis plan. JSi, RB, JE, and VC ( JE and VC are independent trial statisticians) verified the underlying data. JE and VC did the statistical analysis. JSi, VC, TC, JE, CH, and SG interpreted the analyses. JSi managed the study with input from RB and LAW. JSi, CH, AMC, DC, RD, SE, BH, SM, AO, MQ, JSs, CHT, EW, and LAW implemented the study, with JSi acting as online intervention facilitator. JSi, LAW, and RB collected data. JSi wrote the first draft of the report with input from JE, VC, CH, and SG. All authors had full access to all the data, including the raw datasets, and contributed to drafting the report. All authors read and approved the final version of the manuscript and take responsibility for its content and the final decision to submit for publication.
Individual participant data that underlie the results reported in this Article, after de-identification ( text, tables, figures, and appendices), will be shared by the corresponding author upon reasonable request for academic and research purposes, and subject to Data Sharing Agreements. The statistical analysis plan, including the analytical code for the primary analysis, is available in the appendix ( pp 54–55).
We declare no competing interests.
We thank all the carers who participated in this trial. We thank the members of the Project Reference Group ( PRG) for their input and contributions. We are grateful for the advice and support given by the independent Trial Steering Committee ( TSC). The PRG and TSC members did not receive compensation for their contributions; members with experiential expertise were paid an honorarium according to the INVOLVE payment guidelines. For recruiting participants into the study, the project team acknowledges the support of the National Institute for Health Research ( NIHR), through the Clinical Research Network ( division 4). This study was supported by the UK Clinical Research Collaboration-registered King's Clinical Trials Unit at King's Health Partners, which is part funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, King's College London, and the NIHR Evaluation, Trials, and Studies Coordinating Centre. This study, as part of a larger research programme entitled E-support for Families and Friends of Individuals affected by Psychosis, is funded by the NIHR under its Post-Doctoral Research Fellowship ( awarded to JS; reference PDF-2015-08-035). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health and Social Care. The NIHR was not involved in the design and conduct of the study, collection, management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.
Download.pdf ( 1.38 MB) Help with pdf files Supplementary appendix | tech |
TELL Japan hopes to 'build resilience ' with mental health summit | Many of us are still feeling overwhelmed as we struggle to adjust to the pandemic. A growing body of research suggests that nurturing our ability to cope with challenges is an important factor for our well-being, both now and in the future. Against this background, TELL Japan is centering its second annual mental health summit around the theme of “ building resilience. ”
Vickie Skorji, TELL’ s Lifeline Services Director, defines resilience as the ability to cope under pressure and recover from difficulties.
“ We all get stressed, have setbacks, experience loss and emotional pain, ” she says. “ However, a resilient person is someone who recognizes when they are stressed or struggling; who reaches out for support when needed; who can gather or develop tools to help problem solve and work their way through these challenges. ”
Building on the momentum and success of its first mental health summit last year, TELL has expanded the program from one day to two. This year’ s event will take place on April 8 and 9. Friday’ s program will be a hybrid event, allowing participants to attend in-person or virtually, while Saturday will be online only.
“ In TELL’ s 49 years of existence, we’ ve never seen so many people impacted and struggling psychologically, ” Skorji says. “ A hundred people attended our one-day virtual conference last year, but with all sectors of the community impacted, we decided to hold a two-day event this year. Day One looks at issues impacting businesses and organizations, while the focus on Day Two is families, schools and young people. ”
In order to reach a wider audience, TELL has partnered with the American Chamber of Commerce in Japan to connect with businesses across the country. A diverse group of experts from that community — as well as the education, health and wellness sectors — will be lending their time and talents to the event, including a keynote speaker on each day.
Friday’ s main speaker is Kathy Matsui, well-known for her research and expertise on gender diversity and the issues facing women in Japan. The economic and psychological burden of the pandemic has been particularly hard on women, such as mothers who were forced to cut back or give up their work in order to care for children when schools went online.
The keynote address on Saturday will be given by Gail Palmer, an expert in couples and family therapy. She will speak on how reinforcing strong emotional bonds, strengthening connections and helping all members of a family to feel empowered and valued can help them “ bend without breaking, ” according to Skorji.
Even before the pandemic there had been an increase in mental health issues among young people, as growing numbers of them were expressing pessimism about the future and burning out even before embarking on their careers.
“ Sadly the impact of the pandemic has exacerbated these feelings for many young people, leading to a greater number of youths struggling with mental health issues and an increase in the number of youth suicides in Japan, ” Skorji says. “ One of the main reasons for TELL’ s decision to focus on resilience is to provide everyone, and in particular young people, with more skills. We want to help people feel more empowered, so that they can cope, and foster a sense of recovery and optimism. ”
In a COVID-19 update issued on March 2, The World Health Organization reported that the global presence of anxiety and depression had increased by 25% during the first year of the pandemic, with concerns that this trend will continue. Set against this backdrop, TELL invites everyone to join them, building both resilience and hope for the future.
Tickets for the Building Resilience Summit are from ¥2,000 for a single-day online option to ¥6,000 for attendance on both days ( with lunch at the Tokyo American Club venue included on Friday). In-person tickets are limited to 100, with registration closing April 5. For further information on speakers, ticket options and to register, visit www.tellevents.org. | tech |
Manufacturing PMI® At 57.1 Percent; March 2022 Manufacturing ISM® Report On Business® — Apparel & Textile Mills Industries Reported Growth | TEMPE, Ariz. — April 1, 2022 — Economic activity in the manufacturing sector grew in March, with the overall economy achieving a 22nd consecutive month of growth, say the nation’ s supply executives in the latest Manufacturing ISM® Report On Business®.
The report was issued today by Timothy R. Fiore, CPSM, C.P.M., Chair of the Institute for Supply Management® ( ISM) Manufacturing Business Survey Committee:
“ The March Manufacturing PMI® registered 57.1 percent, a decrease of 1.5 percentage points from the February reading of 58.6 percent. This figure indicates expansion in the overall economy for the 22nd month in a row after a contraction in April and May 2020. This is the lowest reading since September 2020 ( 55.4 percent). The New Orders Index registered 53.8 percent, down 7.9 percentage points compared to the February reading of 61.7 percent. The Production Index reading of 54.5 percent is a 4-percentage point decrease compared to February’ s figure of 58.5 percent. The Prices Index registered 87.1 percent, up 11.5 percentage points compared to the February figure of 75.6 percent. The Backlog of Orders Index registered 60 percent, 5 percentage points lower than the February reading of 65 percent. The Employment Index figure of 56.3 percent is 3.4 percentage points higher than the 52.9 percent recorded in February. The Supplier Deliveries Index registered 65.4 percent, a decrease of 0.7 percentage point compared to the February figure of 66.1 percent. The Inventories Index registered 55.5 percent, 1.9 percentage points higher than the February reading of 53.6 percent. The New Export Orders Index reading of 53.2 percent is down 3.9 percentage points compared to February’ s figure of 57.1 percent. The Imports Index registered 51.8 percent, a 3.6-percentage point decrease from the February reading of 55.4 percent. ”
Fiore continues, “ The U.S. manufacturing sector remains in a demand-driven, supply chain-constrained environment. In March, progress was made to solve the labor shortage problems at all tiers of the supply chain, which will result in improved factory throughput and supplier deliveries. Panelists reported lower rates of quits and early retirements compared to previous months, as well as improving internal and supplier labor positions. March brought back increasing rates of price expansion, due primarily to instability in global energy markets. Suppliers are not waiting to experience the full impacts of price increases before negotiating with their customers. Panel sentiment remained strongly optimistic regarding demand, with six positive growth comments for every cautious comment, down from February’ s ratio of 12-to-1. Demand expanded, with the ( 1) New Orders Index remaining in growth territory, supported by weaker growth of new export orders, ( 2) Customers’ Inventories Index remaining at a very low level and ( 3) Backlog of Orders Index continuing in strong growth territory. Consumption ( measured by the Production and Employment indexes) grew during the period, though at a slower rate, with a combined minus-0.6-percentage point change to the Manufacturing PMI® calculation. The Employment Index expanded for a seventh straight month; panelists indicate their ability to hire continues to improve, to a greater degree than in February. Challenges with turnover ( quits and retirements) and resulting backfilling continue to plague panelists’ efforts to adequately staff their organizations, but to a lesser extent compared to February. Amid signs of staffing and supplier delivery improvements, production expanded at disappointing levels, likely due to timing issues. Inputs — expressed as supplier deliveries, inventories, and imports — continued to constrain production expansion. The Supplier Deliveries Index again slowed, but at a slightly slower rate in March, while the Inventories Index increased at a slightly faster rate and the Imports Index grew at a slower rate. The Prices Index increased for the 22nd consecutive month, at a dramatically higher rate compared to February.
“ Five of the six biggest manufacturing industries — Food, Beverage & Tobacco Products; Machinery; Transportation Equipment; Chemical Products; and Computer & Electronic Products — registered moderate-to-strong growth in March.
“ Manufacturing performed well for the 22nd straight month, with demand registering slower month-over-month growth ( likely due to extended lead times) and consumption softening slightly ( due to labor force improvement). Omicron impacts are being felt by overseas partners, and the impact to the manufacturing community is a potential headwind, ” says Fiore.
Fifteen manufacturing industries reported growth in March, in the following order: Apparel, Leather & Allied Products; Furniture & Related Products; Food, Beverage & Tobacco Products; Electrical Equipment, Appliances & Components; Miscellaneous Manufacturing; Machinery; Textile Mills; Transportation Equipment; Fabricated Metal Products; Paper Products; Chemical Products; Computer & Electronic Products; Nonmetallic Mineral Products; Primary Metals; and Plastics & Rubber Products. The two industries reporting a decrease in March compared to February are: Wood Products; and Petroleum & Coal Products.
What Respondents Are Saying
“ No letup yet in supply chain challenges, especially electronic components. Relying more and more on the broker market. ” [ Computer & Electronic Products ]
“ Customer orders are brisk in the face of significant price increases, while we continue to struggle with inbound supplier service and raw material availability issues. ” [ Chemical Products ]
“ Generally speaking, the business environment is slowly improving for aerospace component manufacturers. Supply chain disruptions and still-extending lead times continue to keep purchasing busy. This further causes reevaluation of the current year’ s business plan and cost assumptions. ” [ Transportation Equipment ]
“ Overall business conditions are challenging in both domestic and international transportation. The Russian invasion of Ukraine has created uncertainty in the grain markets, causing upward pricing pressure. In addition, inflationary pressures across all categories have made it challenging to manage cost and profitability. ” [ Food, Beverage & Tobacco Products ]
“ Prices are increasing on steel and steel products after a slight decrease from highs last month. Transportation costs are going up significantly with the increase in fuel prices. ” [ Machinery ]
“ Backlog continues to be strong as we ship delinquent orders resulting from COVID-19 slowdowns. ” [ Fabricated Metal Products ]
“ Demand continues to be strong. Backlog is still increasing — currently at about three months of production. Availability of purchased material continues to constrain production, causing the increased backlog. ” [ Electrical Equipment, Appliances & Components ]
“ Business continues to be strong, with incoming sales higher but still combating labor and material issues like availability and inflation. Still determining impact of the Russian invasion of Ukraine. ” [ Furniture & Related Products ]
“ The supply situation is getting worse, with lead times extending over 12 months, material not available, and suppliers not quoting or taking orders. Prices on the rise daily. ” [ Miscellaneous Manufacturing ]
“ Supply chain is still unstable. While we have seen improvements, there are still a lot of issues that have yet to be resolved. ” [ Primary Metals ]
Mar
Feb
Manufacturing ISM® Report On Business® data is seasonally adjusted for the New Orders, Production, Employment and Inventories indexes.
* Number of months moving in current direction.
Commodities Reported Up/Down In Price And In Short Supply
Commodities Up in Price
Adhesives and Paint ( 4); Aluminum ( 22); Aluminum Products ( 3); Brass; Cable Assemblies ( 2); Caustic Soda; Copper ( 3); Copper Products; Corrugate ( 2); Corrugated Packaging ( 17); Crude Oil ( 3); Diesel Fuel ( 15); Electrical Components ( 16); Electronic Components ( 16); Energy; Fasteners; Freight ( 17); Hydraulic Components; Labor — Temporary ( 11); Logistics Services; Lubricants; Lumber ( 4); Natural Gas ( 9); Nickel; Packaging Supplies ( 16); Pallets ( 2); Paper; Paper Products ( 3); Pigments; Plastic Resins ( 3); Plywood; Polypropylene; Precious Metals; Rubber; Rubber Based Products ( 8); Semiconductors ( 14); Solvents ( 2); Soy Based Products ( 3); Steel * ( 20); Steel — Hot Rolled; Steel — Scrap; Steel — Stainless ( 17); Steel Products * ( 19); Titanium; and Zinc Compounds ( 3).
Commodities Down in Price
Steel * ( 5).
Commodities in Short Supply
Aluminum ( 5); Aluminum Products; Cable Assemblies; Caustic Soda; Electrical Components ( 18); Electronic Components ( 16); Fabricated Metal Products; Food Oils ( 2); Freight; Labor — Temporary ( 11); Lumber; Nickel; Ocean Freight; Packaging Materials; Plastic Resins — Other ( 13); Power Supplies; Printed Circuit Board Assemblies ( 3); Programmable Logic Controllers; Resin Based Products; Rubber Based Products ( 2); Semiconductors ( 16); Steel ( 2); Steel — Stainless; and Wire — Copper.
Note: The number of consecutive months the commodity is listed is indicated after each item.
* Indicates both up and down in price.
March 2022 Manufacturing Index Summaries
Manufacturing PMI®
Manufacturing grew in March, as the Manufacturing PMI registered 57.1 percent, 1.5 percentage points lower than the February reading of 58.6 percent. This is the lowest reading since September 2020, when the composite index registered 55.4 percent. “ The Manufacturing PMI continued to indicate strong sector expansion and U.S. economic growth in March. All five subindexes that directly factor into the Manufacturing PMI® were in growth territory. Five of the six biggest manufacturing industries — Food, Beverage & Tobacco Products; Machinery; Transportation Equipment; Chemical Products; and Computer & Electronic Products — registered moderate-to-strong growth in March. The New Orders and Production indexes remained in expansion territory. The Supplier Deliveries Index softened slightly, and the Inventories Index increased, indicating easing of supply chain congestion. All 10 of the subindexes were positive for the period; a reading of ‘ too low’ for the Customers’ Inventories Index is considered a positive for future production, ” says Fiore. A reading above 50 percent indicates that the manufacturing economy is generally expanding; below 50 percent indicates that it is generally contracting.
A Manufacturing PMI above 48.7 percent, over a period of time, generally indicates an expansion of the overall economy. Therefore, the March Manufacturing PMI indicates the overall economy grew in March for the 22nd consecutive month following contraction in April and May 2020. “ The past relationship between the Manufacturing PMI and the overall economy indicates that the Manufacturing PMI for March ( 57.1 percent) corresponds to a 2.9-percent increase in real gross domestic product ( GDP) on an annualized basis, ” says Fiore.
The Last 12 Months
PMI®
PMI®
High – 61.6
Low – 57.1
New Orders
ISM’ s New Orders Index registered 53.8 percent in March, a decrease of 7.9 percentage points compared to the 61.7 percent reported in February. This indicates that new orders grew for the 22nd consecutive month. While the New Orders Index remains in growth territory, the month-over-month decrease is the largest since a 15.3-percentage point drop in April 2020. “ Five of the six largest manufacturing sectors increased new orders at moderate-to-strong levels: Food, Beverage & Tobacco Products; Transportation Equipment; Chemical Products; Computer & Electronic Products; and Machinery. Price instability, softening lead times and panelists’ order books being full resulted in a pause in new order rates. Backlog and customer inventories remain at very encouraging levels, indicating that demand remains strong in spite of this month’ s slowing in new order expansion, ” says Fiore. A New Orders Index above 52.9 percent, over time, is generally consistent with an increase in the Census Bureau’ s series on manufacturing orders ( in constant 2000 dollars).
Of the 18 manufacturing industries, 13 reported growth in new orders in March, in the following order: Apparel, Leather & Allied Products; Food, Beverage & Tobacco Products; Miscellaneous Manufacturing; Textile Mills; Electrical Equipment, Appliances & Components; Transportation Equipment; Paper Products; Chemical Products; Fabricated Metal Products; Furniture & Related Products; Computer & Electronic Products; Plastics & Rubber Products; and Machinery. The only industry reporting a decline in new orders in March is Petroleum & Coal Products.
Production
The Production Index registered 54.5 percent in March, 4 percentage points lower than the February reading of 58.5 percent, indicating growth for the 22nd consecutive month. “ Of the top six industries, five — Food, Beverage & Tobacco Products; Transportation Equipment; Machinery; Chemical Products; and Computer & Electronic Products — expanded in March. Demand remains strong: Labor and material availability continue to improve, but factories are still struggling to hit optimum output rates, ” says Fiore. An index above 52.4 percent, over time, is generally consistent with an increase in the Federal Reserve Board’ s Industrial Production figures.
The 11 industries reporting growth in production during the month of March — listed in order — are: Apparel, Leather & Allied Products; Food, Beverage & Tobacco Products; Miscellaneous Manufacturing; Textile Mills; Transportation Equipment; Fabricated Metal Products; Electrical Equipment, Appliances & Components; Furniture & Related Products; Machinery; Chemical Products; and Computer & Electronic Products. The four industries reporting a decrease in March are: Paper Products; Primary Metals; Wood Products; and Plastics & Rubber Products.
Employment
ISM’ s Employment Index registered 56.3 percent in March, 3.4 percentage points above the February reading of 52.9 percent. “ The index reported a seventh consecutive month of expansion. Of the six big manufacturing sectors, four ( Transportation Equipment; Food, Beverage & Tobacco Products; Machinery; and Computer & Electronic Products) expanded. Survey panelists’ companies are still struggling to meet labor management plans, but there were signs of improvement compared to February: A larger share of comments ( 12 percent in March, up from 4 percent in February) noted greater hiring ease. An overwhelming majority of panelists again indicate their companies are increasing head counts or attempting to, as 85 percent of Employment Index comments were hiring focused. Among those respondents, 28 percent expressed difficulty in filling positions, down from 34 percent in February. Although turnover rates remained elevated ( 30 percent of comments cited backfills and retirements, a decrease from 38 percent in February), there were indications of hiring improvement and a potential slowing in quits. April will provide better clarity, ” says Fiore. An Employment Index above 50.5 percent, over time, is generally consistent with an increase in the Bureau of Labor Statistics ( BLS) data on manufacturing employment.
Of 18 manufacturing industries, 10 industries reported employment growth in March, in the following order: Apparel, Leather & Allied Products; Furniture & Related Products; Electrical Equipment, Appliances & Components; Transportation Equipment; Food, Beverage & Tobacco Products; Fabricated Metal Products; Machinery; Paper Products; Miscellaneous Manufacturing; and Computer & Electronic Products. The four industries reporting a decrease in employment in March are: Textile Mills; Wood Products; Primary Metals; and Plastics & Rubber Products.
Supplier Deliveries†
The delivery performance of suppliers to manufacturing organizations was slower in March, as the Supplier Deliveries Index registered 65.4 percent, 0.7 percentage point lower than the 66.1 percent reported in February. Of the six top manufacturing industries, five ( Machinery; Computer & Electronic Products; Chemical Products; Food, Beverage & Tobacco Products; and Transportation Equipment) reported slowing deliveries. “ Deliveries slowed at a slightly slower rate compared to the previous month. The index continues to reflect suppliers’ difficulties in meeting demand from panelists’ companies. Supplier labor issues are improving, according to panelists’ comments, and transportation networks are beginning to demonstrate more flexibility, which should support improvement in the index in the second quarter ( Q2), ” says Fiore. ( For more data on lead times, see the Buying Policy section of this report.) A reading below 50 percent indicates faster deliveries, while a reading above 50 percent indicates slower deliveries.
Fifteen of 18 industries reported slower supplier deliveries in March, in the following order: Apparel, Leather & Allied Products; Paper Products; Textile Mills; Machinery; Furniture & Related Products; Nonmetallic Mineral Products; Plastics & Rubber Products; Primary Metals; Fabricated Metal Products; Computer & Electronic Products; Chemical Products; Miscellaneous Manufacturing; Food, Beverage & Tobacco Products; Electrical Equipment, Appliances & Components; and Transportation Equipment. The only industry reporting faster supplier deliveries in March as compared to February is Wood Products.
% Slower
% Same
% Faster
Inventories
The Inventories Index registered 55.5 percent in March, 1.9 percentage points higher than the 53.6 percent reported for February. “ Manufacturing inventories expanded at a faster rate compared to February and are again climbing. Continuing part shortages are evident in ( 1) increased receipts of products from suppliers and ( 2) expansion of work-in-process inventories to manage absorption. Manufacturing inventories will continue to expand through the first half of 2022, as these conditions persist in Q2, ” says Fiore. An Inventories Index greater than 44.4 percent, over time, is generally consistent with expansion in the Bureau of Economic Analysis ( BEA) figures on overall manufacturing inventories ( in chained 2000 dollars).
The 14 industries reporting higher inventories in March — in the following order — are: Apparel, Leather & Allied Products; Furniture & Related Products; Electrical Equipment, Appliances & Components; Textile Mills; Machinery; Nonmetallic Mineral Products; Paper Products; Primary Metals; Chemical Products; Miscellaneous Manufacturing; Food, Beverage & Tobacco Products; Computer & Electronic Products; Transportation Equipment; and Fabricated Metal Products. Only Plastics & Rubber Products reported contracting inventories in March.
Customers’ Inventories†
ISM’ s Customers’ Inventories Index registered 34.1 percent in March, 2.3 percentage points higher than the 31.8 percent reported for February, indicating that customers’ inventory levels were considered too low. “ Customers’ inventories are too low for the 66th consecutive month, a positive for future production growth. For 20 straight months, the Customers’ Inventories Index has been at historically low levels, ” says Fiore.
No industries reported customers’ inventories as too high in March. The 11 industries reporting customers’ inventories as too low during March — listed in order — are: Paper Products; Transportation Equipment; Miscellaneous Manufacturing; Fabricated Metal Products; Plastics & Rubber Products; Machinery; Primary Metals; Computer & Electronic Products; Chemical Products; Food, Beverage & Tobacco Products; and Electrical Equipment, Appliances & Components.
Prices†
The ISM Prices Index registered 87.1 percent, up 11.5 percentage points compared to the February reading of 75.6 percent, indicating raw materials prices increased for the 22nd consecutive month, at a notably faster rate in March. This is the biggest month-over-month increase since a 12.2-percentage point gain ( to 77.6 percent) in December 2020; the Prices Index has since exceeded 70 percent in 15 out of 16 months. The index has been above 60 percent for 19 months in a row. “ Aluminum, packaging materials, copper, electrical and electronic components, petroleum products, vegetable oils, lumber and paper products, freight, rubber based products, and stainless steel remain at elevated prices, thanks to product scarcity and high demand. A reversal of steel product price declines and the dramatic increase in energy costs has led to a resumption of overall prices growth, reversing what appeared to be a post-omicron softening, ” says Fiore. A Prices Index above 52.6 percent, over time, is generally consistent with an increase in the Bureau of Labor Statistics ( BLS) Producer Price Index for Intermediate Materials.
In March, all 18 industries reported paying increased prices for raw materials, in the following order: Apparel, Leather & Allied Products; Nonmetallic Mineral Products; Paper Products; Printing & Related Support Activities; Textile Mills; Primary Metals; Transportation Equipment; Machinery; Plastics & Rubber Products; Chemical Products; Miscellaneous Manufacturing; Computer & Electronic Products; Fabricated Metal Products; Food, Beverage & Tobacco Products; Electrical Equipment, Appliances & Components; Furniture & Related Products; Petroleum & Coal Products; and Wood Products.
Prices
Backlog of Orders†
ISM’ s Backlog of Orders Index registered 60 percent in March, a 5-percentage point decrease compared to the 65 percent reported in February, indicating order backlogs expanded for the 21st straight month. “ Backlogs expanded at a slower rate in March, indicating that incoming business remains high, with output still below its maximum potential, ” says Fiore. Of the six big manufacturing sectors, five reported expanded backlogs: Food, Beverage & Tobacco Products; Transportation Equipment; Computer & Electronic Products; Chemical Products; and Machinery.
Eleven industries reported growth in order backlogs in March, in the following order: Apparel, Leather & Allied Products; Food, Beverage & Tobacco Products; Textile Mills; Transportation Equipment; Fabricated Metal Products; Computer & Electronic Products; Paper Products; Plastics & Rubber Products; Chemical Products; Machinery; and Miscellaneous Manufacturing. The two industries reporting lower backlogs in March are: Nonmetallic Mineral Products; and Primary Metals.
% Higher
% Same
% Lower
New Export Orders†
ISM’ s New Export Orders Index registered 53.2 percent in March, down 3.9 percentage points compared to the February reading of 57.1 percent. “ The New Export Orders Index grew for the 21st consecutive month, at a slower rate in March. Of the six big industry sectors, three ( Computer & Electronic Products; Transportation Equipment; and Food, Beverage & Tobacco Products) expanded, ” says Fiore.
The six industries reporting growth in new export orders in March — in the following order — are: Wood Products; Miscellaneous Manufacturing; Computer & Electronic Products; Transportation Equipment; Food, Beverage & Tobacco Products; and Fabricated Metal Products. The only industry reporting a decrease in new export orders in March is Machinery. Ten industries reported no change in exports in March as compared to February.
% Higher
% Same
% Lower
Imports†
ISM’ s Imports Index registered 51.8 percent in March, a decrease of 3.6 percentage points compared to February’ s figure of 55.4 percent. “ Imports expanded in March, but the index posted its lowest reading since it contracted ( 49.1 percent) in October 2021. Fundamental demand remains strong, but satisfying that demand has been complicated by COVID-19 issues in Asia. Imports will likely continue to be challenged through the first half of 2022, due to the pandemic and labor management negotiations at West Coast ports, ” says Fiore.
The seven industries reporting growth in imports in March — in the following order — are: Furniture & Related Products; Nonmetallic Mineral Products; Transportation Equipment; Food, Beverage & Tobacco Products; Computer & Electronic Products; Electrical Equipment, Appliances & Components; and Machinery. Four industries — Paper Products; Plastics & Rubber Products; Miscellaneous Manufacturing; and Chemical Products — reported lower volumes of imports in March. Seven industries reported no change in imports in March.
% Higher
% Same
% Lower
Index
†The Supplier Deliveries, Customers’ Inventories, Prices, Backlog of Orders, New Export Orders, and Imports indexes do not meet the accepted criteria for seasonal adjustments.
Buying Policy
The average commitment lead time for Capital Expenditures in March was 172 days, a decrease of one day compared to February. CapEx lead times have increased in nine of the last 12 months, for a net gain of 25 days since April 2021 ( 147 days). Average lead time in March for Production Materials decreased by one day, to 96 days. Average lead time for Maintenance, Repair and Operating ( MRO) Supplies decreased two days, to 48 days. | general |
My five-year-old is now eligible for a COVID vaccine – should I get them immunised? | Since 2020, we’ ve heard that COVID is mainly a problem for the elderly or vulnerable. Vaccines have dramatically improved their protection against the disease, but children and younger people – because it’ s perceived that COVID poses little risk to them – have remained at the bottom of the list when it comes to immunisations. COVID vaccines are only now becoming available for under-12s in the UK.
The health secretary has deemed vaccinating 5- to 11-year-olds “ non-urgent ”, which I think is wrong, as I have argued previously. Like many parents, I have witnessed a tidal wave of COVID in our schools in recent months, as the government has prioritised school attendance while removing most measures to contain the virus. Thankfully, I don’ t personally know any children that have suffered severe disease or developed long COVID. But that doesn’ t mean this doesn’ t happen – we need to consider the population as a whole, as we might for road traffic accidents, for example.
So I strongly support the childhood COVID vaccine, and not just as a virologist, but as a parent too. I am among the unlucky few to experience a child becoming seriously unwell, my son being admitted to hospital at just 14 weeks with bacterial meningitis. My wife somehow endured staying with him through lumbar punctures, injections and sleepless nights while I cared for our daughter; we were all overwhelmed. Timely antibiotics thankfully spared my boy from the worst, but on subsequent clinic visits I witnessed first-hand how lucky we had been. If he had been older, further childhood vaccines would likely have prevented it happening.
Working to make a difference in the world but struggling to save for a home. Trying to live sustainably while dealing with mental health issues. For those of us in our twenties and thirties, these are the kinds of problems we deal with every day. This article is part of Quarter Life, a series that explores those issues and comes up with solutions.
Small percentage risks can often sound reassuring, and indeed, the risks of young children getting severely ill from COVID are small when compared to the risks for adults. But this is the wrong comparison. The reality is that with COVID continuing to be so prevalent, the percentage risk posed by the disease translates into ever more severe cases in children. This becomes more apparent when you look at their risk separately from adults and see how COVID is affecting children’ s health.
Children simply don’ t die in great numbers compared to adults, as we would hope, and public health has seen steadily reducing juvenile death rates since the 1980s. In 2020, there were fewer than 800 deaths in children aged between one and 15, with only 20 or so attributed to COVID. However, the return to schools in 2021 saw this increase dramatically, with over 120 COVID deaths in under-19s according to the Office for National Statistics. Under-18s represented over 8% of hospitalisations during the January omicron peak, and COVID is now among the top causes of childhood mortality in the UK.
On top of the initial infection, the impact of long COVID upon a child’ s life is almost unimaginable. Thousands of children have experienced debilitating illness for more than 12 months after catching the coronavirus, some even since the beginning of the pandemic, and cases are growing. Plus, we have yet to determine the full impact of omicron.
Knowing that COVID causes other long-term complications – such as organ damage and, specifically in children, paediatric multi-system inflammatory syndrome – and that vaccines can prevent infection and are highly effective at preventing severe COVID disease and death, protecting young children with them is surely a no-brainer. The notion that children can gain future protection by catching the coronavirus is irresponsible by comparison.
Parents rightly worry about new medicines, which have the potential to cause rare and possibly severe side-effects. One that has come to light is inflammation of the heart ( known as myocarditis). It’ s a particular issue in male adolescents, but the risk has been reduced in this age group in the UK by increasing the gap between young people’ s first and second doses. It also appears to be vanishingly rare in younger children because they receive a smaller vaccine dose. This risk far outweighed by the potential for adverse effects from the virus, including more severe and long-lasting heart inflammation stemming from infection.
Much like a seatbelt, in the rare event that it’ s needed to stave off the worst, I’ d much rather my child have a COVID vaccine than be without one. Nobody knows what may follow omicron, or how the wave of its new, even more infectious BA.2 sub-variant will play out – so why not protect against the relatively slim chance of tragic consequences? There is no such thing as a “ mild hospitalisation ”, especially when it’ s your child on the ward.
You only need look at the comparatively well vaccinated over-16s group to see what difference could be made in terms of avoiding school disruption and improving safety for kids and staff alike. Reduced community transmission will be essential if we are ever to truly “ live with ” the virus. Our safe and effective vaccines lay the path towards this goal, the sooner we take it the better for all. | business |
15 Trending MLOps Talks You can Access for Free at ODSC East 2022 | Covering topics like workflows and full-stack machine learning, these are 15 free MLOps talks coming to # ODSCEast 2022 that you can see with a free Bronze Pass.
MLOps and data workflows are one of 2022 most trending topics. Here's just a sample of 15 of over 110 free talks from leaders in MLOps that you just shouldn’ t miss this April 19th-21st at ODSC East 2022. Grab a free Bronze Pass and attend in-person or virtually.
Editor's note: Abstracts are abbreviated. Please check out the schedule for full abstracts.
MLOps is a hot topic, as teams grapple with productionizing machine learning. Now, they need monitoring, lineage, and deployment tools, not just modeling libraries. This talk introduces tools from Databricks, like open-source MLflow and Delta, as well as a Feature Store, and how they help mitigate MLOps pain points.
Machine learning systems in production are subject to performance degradations due to many external factors and it is vital to actively monitor system stability and integrity. A common source of model degradation is due to the inherent non-stationarity of the real-world environment, commonly referred to as data drift. In this presentation, I will describe how to reliably quantify data drift in a variety of different data paradigms including tabular data, computer vision data, and NLP data. Attendees of this talk will come away with a conceptual toolkit for thinking about data stability monitoring in their own models, with example use cases in common settings as well as in more challenging regimes.
We’ ll present a high-level overview of the 8 layers of the ML stack: data, compute, versioning, orchestration, software architecture, model operations, feature engineering, and model development. We’ ll present a schematic as to which layers data scientists need to be thinking about and working with, and then introduce attendees to the tooling and workflow landscape. In doing so, we’ ll present a widely applicable stack that provides the best possible user experience for data scientists, allowing them to focus on parts they like ( modeling using their favorite off-the-shelf libraries) while providing robust built-in solutions for the foundational infrastructure.
We’ ll also see how to begin integrating other tools into our pipelines, such as dbt for data transformation, great expectations for data validation, Weights & Biases for experiment tracking, and Amazon Sagemaker for model deployment.
In machine learning, e.g. recommendation tools or data classification, data is often represented as high-dimensional vectors. These vectors are stored in so-called vector databases. With vector databases, you can efficiently run searching, ranking, and recommendation algorithms. Therefore, vector databases became the backbone of ML deployments in the industry.
This session is all about vector databases. If you are a data scientist or data/software engineer this session would be interesting for you. You will learn how you can easily run your favorite ML models with the vector database Weaviate. You 'll get an overview of what a vector database like Weaviate can offer: such as semantic search, question answering, data classification, named entity recognition, multimodal search, and much more. After this session, you are able to load in your own data and query it with your preferred ML model!
Working with big data matrices is challenging, Kubernetes allows users to elastically scale, but can only have a pod as large as a node, which may not be large enough to fit the matrix in memory. While Kubernetes allows for other paradigms on top of it which allows pods to coordinate on individual jobs, setting them up and making them play nice with ML platforms is not straightforward. Using Apache Spark and Apache Mahout we can work with matrices of any dimension and distribute them across an unbounded number of pods/nodes, and we can use Kubeflow to make our work quickly and easily reproducible. In this talk, we’ ll discuss how we used Apache Spark and Mahout to denoise DICOM images of lungs of COVID patients and published our Pipeline with Kubeflow to make the process easily repeatable which could help doctors in more resource-limited hospitals, as well as other researchers seeking to automate the detection of COVID.
There is a pressing need for tools and workflows that meet data scientists where they are. This is also a serious business need: How to enable an organization of data scientists, who are not software engineers by training, to build and deploy end-to-end machine learning workflows and applications independently. In this talk, we discuss the problem space and the approach we took to solving it with Metaflow, the open-source framework we developed at Netflix, which now powers hundreds of business-critical ML projects at Netflix and other companies from bioinformatics and drones to real estate. We wanted to provide the best possible user experience for data scientists, allowing them to focus on parts they like ( modeling using their favorite off-the-shelf libraries) while providing robust built-in solutions for the foundational infrastructure: data, compute, orchestration, and versioning. In this talk, you will learn about:
In this talk, we will explain how Quine works under the hood, discuss some of the interesting and brain-bending challenges we had to confront in order to create it, and show some use cases to illustrate why it's important for modern data pipelines. Quine implements a property-graph data model on top of an asynchronous graph computational model. It's like Pregel with Actors. Each node is capable of performing arbitrary computation, so we can bake in some powerful capabilities deep in the graph, and then package it up for easy use into user-contributed `` recipes ' ' available in the Github repo. Quine is free and open to all, available at https: //quine.io, and actively supported by thatDot and the community.
There’ s a vibrant ecosystem of choices available for data scientists to perform their job. This spans programming languages – such as Python, R, and Java – as well as integrated development environments, deployment technologies, virtual machines, Kubernetes, and more.
While these choices create a lot of opportunities, they also can lead to option fatigue, resulting in an overcrowded, uneven landscape that makes it difficult to scale analytics and create business value. In this talk, data scientist Marinela Profi will explain how ModelOps and MLOps can help you streamline and simplify the process. She’ ll discuss the difference between the two approaches and the important role they play in solving common challenges with the ML lifecycle. Taking it a step further, she will introduce the concept of an analytics platform to develop, deploy and monitor any type of model to adopt a full life cycle approach. She’ ll also discuss how to integrate different open source packages and ensure that proper model governance and auditability best practices remain in place.
In recent years, advances in data science have made tremendous progress yet designing large-scale data science and machine learning applications still remain challenging. The variety of machine learning frameworks, hardware accelerators, cloud vendors as well as the complexity of data science workflows brings new challenges to MLOps. It’ s non-trivial for data scientists to easily launch, manage, monitor, and optimize their pipelines in a scalable way. On the other hand, Kubernetes and containerization have revolutionized cloud applications in a manner not seen since Linux and virtualization's disruption of the server market. In this talk, we’ ll provide an overview of the existing tools available and best practices to do MLOps effectively in the cloud-native era.
# 10: AI Observability: How To Fix Issues With Your ML Model: Danny D. Leybzon | MLOps Architect | WhyLabs
When machine learning models are deployed to production, their performance starts degrading. Now that ML models are increasingly becoming mission-critical for enterprises and startups alike, root cause analysis and gaining observability into your AI systems are similarly mission-critical. However, many organizations struggle to prevent model performance degradation and assure the quality of the data being fed to their ML models, largely because they don't have the tools and organizational knowledge to do so.
In this talk, MLOps Architect Danny D. Leybzon will explain the problems associated with ML models deployed in production, and how many of these problems can be addressed with data monitoring and AI observability best practices. Taking it a step further, the speaker will discuss steps that data scientists and machine learning engineers can take to proactively ensure the performance of their models, rather than reacting to the impacts of performance degradation reported by their customers. ''
MLRun is an open-source MLOps orchestration framework. It exists to accelerate the integration of AI/ML applications into existing business workflows. MLRun introduces Data Scientists to a simple Python SDK that transforms their code into a production-quality application. It does so by abstracting the many layers involved in the MLOps pipeline. Developers can build, test, and tune their work anywhere and leverage MLRun to integrate with other components of their business workflow. The capabilities of MLRun are extensive, and we will cover the basics to get you started. You will leave this session with enough information to:
In this session, we will describe the challenges in operationalizing machine & deep learning. We’ ll explain the production-first approach to MLOps pipelines - using a modular strategy, where the different components provide a continuous, automated, and far simpler way to move from research and development to scalable production pipelines. Without the need to refactor code, add glue logic, and spend significant efforts on data and ML engineering.
We will cover various real-world implementations and examples, and discuss the different stages, including automating feature creation using a feature store, building CI/CD automation for models and apps, deploying real-time application pipelines, observing the model and application results, creating a feedback loop and re-training with fresh data.
When it comes to MLops, storage and data are related — but far from the same. We're here to help you focus on data and not think about storage. We're going to do this in two ways: First, we 'll show you how Pure gets out of the way of data science. Second, we 'll show you how Pure delivers a modern data experience. The combination results in faster time to insights and more models quickly getting into Production.
MLOps requires collaboration amongst data scientists, developers, ML engineers, IT operations, and various DevOps technologies. This can require significant effort and coordination. We’ ll briefly discuss how data scientists build, test, and train ML models on Kubernetes hybrid cloud platforms such as Red Hat OpenShift. Next, we will explore how the integrated DevOps CI/CD capabilities in Red Hat OpenShiftⓇ ( i.e., GitOps and Pipelines), allow us to automate and accelerate the integration of ML models into the application development process. Ultimately, these capabilities allow consistent, scaled application deployments, which also helps accelerate the frequent redeployment of updated ML models into production.
# 15: Reproducibility, ML Pipelines, and CI/CD in Computer Vision Projects: Alex Kim | Solutions Engineer | Iterative.ai
In the last few years, training a well-performing Computer Vision ( CV) model in Jupyter Notebooks became fairly straightforward if you use pre-trained Deep Learning models and high-level libraries that abstract away much of the complexity ( fastai, keras, pytorch-lightning are just a few examples). The hard part is still incorporating this model into an application that runs in a production environment bringing value to the customers and our business.A typical ML project lifecycle goes through 3 phases which we will expand on:
In this talk, I’ ll describe an approach that streamlines all three phases. As our demo project, I’ ve selected a very common deployment pattern in CV projects: a CV model wrapped in a web API service. Automatic defect detection is an example problem I am addressing with this pattern. I assume the target audience of this talk to be technical folks ( e.g. Software Engineers, ML Engineers, Data Scientists) who are familiar with the general Machine Learning concepts, Python programming, CI/CD processes, and Cloud infrastructure. | tech |
How does Jumbo-Visma fill its Wout-shaped hole at Flanders? | For all of their victories in the past years on their rise to the top, Jumbo-Visma seem to have a certain talent for misfortune. Wout van Aert’ s horrible, season-ending crash at the 2019 Tour de France, Primož Roglič’ s various, sometimes unexplained mishaps that see him toss away GC leads. Most famously, of course, at the Tour That Must Not Be Named.
Now, the crisis three days before the start of the Tour of Flanders is that Wout van Aert has COVID-19 and will not take the start in Antwerp come Sunday. And it’ s all anyone is talking about.
The first six questions at the press conference with Tiesj Benoot and Christophe Laporte, the men instructed to now pick up the pieces, are aimed at the team’ s press officer.
“ Before we begin, ” the press officer says. “ There is no update on Wout yet. ”
“ But a decision will be made today or tomorrow? ”
“ It’ s difficult to say but the decision will be communicated. ”
“ Is he still at home? ”
“ Yeah. ”
“ And who will replace Wout if he can’ t race? ”
“ …it will be Mick van Dijke ”.
“ Ok. ”
And now, we begin the press conference with the two riders sat in front of us who will definitely ( almost definitely) be riding the race. | general |
Why AI? Implications for the Healthcare Industry | AI is a social technology that relies on how human beings interact and respond with the world around them. What makes the technology so powerful is its ability to process data in an intelligent way and continuously apply it to solve reoccurring complex problems in an adaptive manner.
When AI adapts through progressive learning, it essentially programs itself by learning from data, it finds structure and regularities in data so that its learning algorithms can acquire a certain degree of logic.
With this core ability to continuously analyze data using neural networks, deeper networks develop multiple layers to them. Through learning from deep neural networks, AI applications achieve a high level of accuracy, ultimately making the AI intelligent. It is this repetitive learning and discovery process through data that optimizes the output from AI to transcend from simply automated/repetitive tasks to high frequency, logical computerized operations.
In the medical field, AI techniques from deep learning and object recognition can now pinpoint cancer on medical images with improved accuracy. Google’ s AI tool can flag cancerous cells better than clinicians. Its software detected cancers at higher rates than radiologists, with fewer false positives.1An AI algorithm could never replace the work of radiologists or physicians, but it will remain an essential guiding tool that can complement their practice. By the same token, the COVID-19 pandemic and a rise in cancer patient numbers has put pressure on medical infrastructure resulting in more common burnout and regional shortages among radiologists across the globe.
AI in the healthcare sector features prominently in a number of roles: health services management, predictive medicine, patient data and diagnostics, and clinical decision-making. Because AI technologies can ingest, analyze, and report large volumes of data across different mo
Copyright © 2021-2022 The Yuan All Rights Reserved. | tech |
CONTAINER PREMIUMS: Market continues lull amid Chinese output slowdowns | Center-South Brazil's crop officially started on April 1, and although more than 70% of the expected...
Gas-fired power burn in the Lone Star State has averaged its lowest level in more than a decade this...
The Permian Basin's Waha Hub spot gas has gained nearly 50 cents in the last three trading sessions...
The all-inclusive spot market into the US was level during the week ending April 1 as post-Lunar New Year demand had yet to recover and North Asian cities remained largely under lockdown as coronavirus cases spread.
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The Asia-US premium spot market has been in decline in recent months, as the Lunar New Year and Beijing Olympics put a hold on US import demand, which has yet to return in full force as the market is in the seasonal spring off-period.
But intermodal issues persist as landside market forces have yet to find balance amid a dearth of chassis and non-fluid rail networks.
`` In my opinion, the only market force that could realistically push rates down is lower volume, '' said a US-based freight forwarder. `` There is a lull from CNY return. ''
During the week ending April 1, S & P Global Commodity Insights heard market value rates into the US West Coast at the $ 8,000 to $ 10,000/FEU levels as wider pockets of FAK space opened up, while some premiums were closer to $ 13,000/FEU for rapid loadings.
The USEC and Gulf markets remain under pressure, however, amid strong demand and widespread congestion at key ports such as Charleston, South Carolina, Norfolk, and Houston.
Similarly, the FAK spot rate from North Asia to North America held firm during the week, and PCR13—Asia to USWC—was assessed March 31 at $ 8,000/FEU, a discount of $ 4,000/FEU to North Asian cargoes bound for the US Atlantic Coast.
`` As of late, not a lot of premiums, '' said another US freight forwarder. `` There's still some, but it's been a lot less than what it was. We anticipate that tide to begin to turn as we turn the corner to peak. ''
The all-inclusive premium rates were stable in the Southeast Asia-to-North America trade lane as lower manufacturing in China was offset by concerns of supply chain disruptions and higher fuel costs, sources said.
The average freight for Southeast Asia to North America was heard at $ 17,000- $ 18,000/FEU for East Coast and $ 15,000- $ 16,000/FEU for West Coast, unchanged from a week ago.
`` The demand is rather weak as many manufacturing units in China have come to a halt amid ongoing COVID shutdowns... we are also getting some discounted rates from carriers like OOCL but, overall, there is no decline in prices due to anticipation of a cargo backlog and port congestion when lockdown is lifted, '' a source based in Singapore said.
The truckers ' shortage in not just China but also the US, the UK, and Canada, continue to stress the supply chain further, the source added.
Meanwhile, some carriers also announced GRIs of 2,700/TEU and 3,000/FEU on the Asia-North America route, effective May 1, two sources said.
`` The carriers are trying to push GRIs expecting heavy cargo volumes in May but it's unlikely that such steep increases will materialize, '' a freight forwarder based in India said.
Container rates on the Indian Subcontinent-to-East Coast North America trade route remained stable at elevated levels as equipment shortage and blank sailings continue to plague the market, sources said.
On the first day of its launch, Platts Container Rate 39—Indian Subcontinent-to-East Coast North America—was assessed at $ 13,000/FEU and PCR40—East Coast North America-to-Indian Subcontinent—at $ 1,500/FEU.
`` Most carriers have reduced capacity allotment [ s ] in India despite a slowdown in global trade amid the ongoing Russia [ -Ukraine ] war and China shutdowns... there is no clear explanation but they keep using capacity crunch as an excuse to quote high rates, '' a freight forwarder based in India said.
The rising bunker fuel costs may usher in more troubles, the freight forwarder added.
To complement the spot container freight rate on the route, S & P Global Commodity Insights has also launched two daily Platts container freight bunker charge assessments and two daily Platts container bunker excluded assessments for the Indian Subcontinent to East Coast North America shipping lane, effective April 1.
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Merck & Co Inc Stock Quote: MRK Stock News, Quotes, Analysis | Merck & Co Inc ( MRK) - DEVELOPS PRESCRIPTION DRUGS IN THE AREAS OF DIABETES, OBESITY, RESPIRATORY, CARDIOVASCULAR, WOMEN 'S HEALTH.
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Aurinia ( AUPH) gains on rumors of a potential acquisition yet again. Reportedly, the company is being eyed by Novartis.
FDA panel votes for Merck's ( MRK) COVID-19 antiviral pill. AbbVie ( ABBV) seeks approval for Skyrizi for Crohn's disease in Europe
Merck ( MRK) is seeking label expansion for Vaxneuvance for use in pediatric patients aged six weeks through 17 years for the prevention of invasive pneumococcal disease. A decision is expected by on Apr 1, 2022.
FDA grants priority review to AstraZeneca ( AZN) and Merck's ( MRK) sNDA for Lynparza for BRCA-mutated HER2-negative high-risk early breast cancer.
An FDA committee voted 13-0 to recommend authorization of Merck's ( MRK) antiviral pill to treat COVID-19.
Go beyond breakouts and learn about 4 buy signals for early entries and adding on. | business |
Screening and vaccination against COVID-19 to minimise school closure: a modelling study - The Lancet Infectious Diseases | BackgroundSchools were closed extensively in 2020–21 to counter SARS-CoV-2 spread, impacting students ' education and wellbeing. With highly contagious variants expanding in Europe, safe options to maintain schools open are urgently needed. By estimating school-specific transmissibility, our study evaluates costs and benefits of different protocols for SARS-CoV-2 control at school.MethodsWe developed an agent-based model of SARS-CoV-2 transmission in schools. We used empirical contact data in a primary and a secondary school and data from pilot screenings in 683 schools during the alpha variant ( B.1.1.7) wave in March–June, 2021, in France. We fitted the model to observed school prevalence to estimate the school-specific effective reproductive number for the alpha ( Ralpha) and delta ( B.1.617.2; Rdelta) variants and performed a cost–benefit analysis examining different intervention protocols.FindingsWe estimated Ralpha to be 1·40 ( 95% CI 1·35–1·45) in the primary school and 1·46 ( 1·41–1·51) in the secondary school during the spring wave, higher than the time-varying reproductive number estimated from community surveillance. Considering the delta variant and vaccination coverage in Europe as of mid-September, 2021, we estimated Rdelta to be 1·66 ( 1·60–1·71) in primary schools and 1·10 ( 1·06–1·14) in secondary schools. Under these conditions, weekly testing of 75% of unvaccinated students ( PCR tests on saliva samples in primary schools and lateral flow tests in secondary schools), in addition to symptom-based testing, would reduce cases by 34% ( 95% CI 32–36) in primary schools and 36% ( 35–39) in secondary schools compared with symptom-based testing alone. Insufficient adherence was recorded in pilot screening ( median ≤53%). Regular testing would also reduce student-days lost up to 80% compared with reactive class closures. Moderate vaccination coverage in students would still benefit from regular testing for additional control—ie, weekly testing 75% of unvaccinated students would reduce cases compared with symptom-based testing only, by 23% in primary schools when 50% of children are vaccinated.InterpretationThe COVID-19 pandemic will probably continue to pose a risk to the safe and normal functioning of schools. Extending vaccination coverage in students, complemented by regular testing with good adherence, are essential steps to keep schools open when highly transmissible variants are circulating.FundingEU Framework Programme for Research and Innovation Horizon 2020, Horizon Europe Framework Programme, Agence Nationale de la Recherche, ANRS–Maladies Infectieuses Émergentes.
Schools were closed extensively in 2020–21 to counter SARS-CoV-2 spread, impacting students ' education and wellbeing. With highly contagious variants expanding in Europe, safe options to maintain schools open are urgently needed. By estimating school-specific transmissibility, our study evaluates costs and benefits of different protocols for SARS-CoV-2 control at school.
We developed an agent-based model of SARS-CoV-2 transmission in schools. We used empirical contact data in a primary and a secondary school and data from pilot screenings in 683 schools during the alpha variant ( B.1.1.7) wave in March–June, 2021, in France. We fitted the model to observed school prevalence to estimate the school-specific effective reproductive number for the alpha ( Ralpha) and delta ( B.1.617.2; Rdelta) variants and performed a cost–benefit analysis examining different intervention protocols.
We estimated Ralpha to be 1·40 ( 95% CI 1·35–1·45) in the primary school and 1·46 ( 1·41–1·51) in the secondary school during the spring wave, higher than the time-varying reproductive number estimated from community surveillance. Considering the delta variant and vaccination coverage in Europe as of mid-September, 2021, we estimated Rdelta to be 1·66 ( 1·60–1·71) in primary schools and 1·10 ( 1·06–1·14) in secondary schools. Under these conditions, weekly testing of 75% of unvaccinated students ( PCR tests on saliva samples in primary schools and lateral flow tests in secondary schools), in addition to symptom-based testing, would reduce cases by 34% ( 95% CI 32–36) in primary schools and 36% ( 35–39) in secondary schools compared with symptom-based testing alone. Insufficient adherence was recorded in pilot screening ( median ≤53%). Regular testing would also reduce student-days lost up to 80% compared with reactive class closures. Moderate vaccination coverage in students would still benefit from regular testing for additional control—ie, weekly testing 75% of unvaccinated students would reduce cases compared with symptom-based testing only, by 23% in primary schools when 50% of children are vaccinated.
The COVID-19 pandemic will probably continue to pose a risk to the safe and normal functioning of schools. Extending vaccination coverage in students, complemented by regular testing with good adherence, are essential steps to keep schools open when highly transmissible variants are circulating.
EU Framework Programme for Research and Innovation Horizon 2020, Horizon Europe Framework Programme, Agence Nationale de la Recherche, ANRS–Maladies Infectieuses Émergentes.
School closure has been extensively used worldwide against the COVID-19 pandemic. The first wave resulted in many countries going into strict lockdowns, closing schools for long periods of time,1UNESCOEducation: from disruption to recovery.https: //en.unesco.org/covid19/educationresponseDate: March 4, 2020Date accessed: May 20, 2021Google Scholar and their reopening has been continuously challenged by successive waves and the need for physical-distancing restrictions. In Europe, depending on the country, students lost from 10 weeks to almost 50 weeks of school from March, 2020, to October, 2021, due to partial or total school closures ( figure 1A). Strategies were affected by the limited understanding of viral circulation in children and their contribution to transmission.2Goldstein E Lipsitch M Cevik M On the effect of age on the transmission of SARS-CoV-2 in households, schools, and the community.J Infect Dis. 2021; 223: 362-369Google ScholarFigure 1School closure in Europe, empirical contact network features, and field screening data in schools in FranceShow full caption ( A) Number of in-presence weeks lost by students in European countries because of school closures due to the pandemic.1UNESCOEducation: from disruption to recovery.https: //en.unesco.org/covid19/educationresponseDate: March 4, 2020Date accessed: May 20, 2021Google Scholar ( B) Daily mean number of distinct contacts per individual within the class or between classes; horizontal dashed lines represent the mean class size, which was 23·2 students ( SD 1·4) in the primary school and 35·8 ( 4·1) in the secondary school. ( C) Daily mean time that an individual spends in interaction with contacts within the class or in other classes. ( D) Daily mean time that a teacher or student spends in interaction with contacts. In panels B–D, histogram bars refer to the empirical networks, and points and error bars ( with 95% bootstrap CIs) refer to the synthetic networks. In panels B and C, the increase in average number of contacts and duration in the synthetic secondary school networks compared with their empirical counterparts is due to the ad-hoc addition of contacts between school years. In panel D, no empirical data is shown for teachers in secondary schools as they did not participate in the data collection and their contact behaviour was inferred from another dataset ( appendix p 15). ( E) Number of schools participating in the pilot screenings during the spring 2021 wave in the Ain, Loire, and Rhône departments. ( F) Observed adherence to screening; boxplots represent the median ( middle line), IQR ( box limits), and 2·5th and 97·5th percentiles ( whiskers). ( G) Number of schools participating in the pilot screenings and weekly incidence ( dotted line) over time from community surveillance in the Ain, Loire, and Rhône departments during the 2021 spring wave; the vertical shaded areas indicate the school closures.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Number of in-presence weeks lost by students in European countries because of school closures due to the pandemic.1UNESCOEducation: from disruption to recovery.https: //en.unesco.org/covid19/educationresponseDate: March 4, 2020Date accessed: May 20, 2021Google Scholar ( B) Daily mean number of distinct contacts per individual within the class or between classes; horizontal dashed lines represent the mean class size, which was 23·2 students ( SD 1·4) in the primary school and 35·8 ( 4·1) in the secondary school. ( C) Daily mean time that an individual spends in interaction with contacts within the class or in other classes. ( D) Daily mean time that a teacher or student spends in interaction with contacts. In panels B–D, histogram bars refer to the empirical networks, and points and error bars ( with 95% bootstrap CIs) refer to the synthetic networks. In panels B and C, the increase in average number of contacts and duration in the synthetic secondary school networks compared with their empirical counterparts is due to the ad-hoc addition of contacts between school years. In panel D, no empirical data is shown for teachers in secondary schools as they did not participate in the data collection and their contact behaviour was inferred from another dataset ( appendix p 15). ( E) Number of schools participating in the pilot screenings during the spring 2021 wave in the Ain, Loire, and Rhône departments. ( F) Observed adherence to screening; boxplots represent the median ( middle line), IQR ( box limits), and 2·5th and 97·5th percentiles ( whiskers). ( G) Number of schools participating in the pilot screenings and weekly incidence ( dotted line) over time from community surveillance in the Ain, Loire, and Rhône departments during the 2021 spring wave; the vertical shaded areas indicate the school closures.
COVID-19 outbreaks in schools are difficult to document, as infections in children are mostly asymptomatic or present mild non-specific symptoms.3Han MS Choi EH Chang SH et al.Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea.JAMA Pediatrics. 2021; 175: 73Google Scholar Despite the lower susceptibility to infections in children than in adults,4Viner RM Mytton OT Bonell C et al.Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis.JAMA Pediatrics. 2021; 175: 143Google Scholar viral circulation can occur in school settings, especially in secondary schools.2Goldstein E Lipsitch M Cevik M On the effect of age on the transmission of SARS-CoV-2 in households, schools, and the community.J Infect Dis. 2021; 223: 362-369Google Scholar Accumulating evidence is consistent with increased transmission in the community if schools are open,2Goldstein E Lipsitch M Cevik M On the effect of age on the transmission of SARS-CoV-2 in households, schools, and the community.J Infect Dis. 2021; 223: 362-369Google Scholar, 5Li Y Campbell H Kulkarni D et al.The temporal association of introducing and lifting non-pharmaceutical interventions with the time-varying reproduction number ( R) of SARS-CoV-2: a modelling study across 131 countries.Lancet Infect Dis. 2021; 21: 193-202Google Scholar and model-based findings suggest that school closure might be used as an additional brake against the COVID-19 pandemic if other physical-distancing options are exhausted or undesired.6Rozhnova G van Dorp CH Bruijning-Verhagen P et al.Model-based evaluation of school- and non-school-related measures to control the COVID-19 pandemic.Nat Commun. 2021; 121614Google Scholar, 7Di Domenico L Pullano G Sabbatini CE Boëlle P-Y Colizza V Modelling safe protocols for reopening schools during the COVID-19 pandemic in France.Nat Commun. 2021; 121073Google Scholar
Keeping schools safely open remains a primary objective that goes beyond educational needs, affecting the social and mental development of children,8Ford T John A Gunnell D Mental health of children and young people during pandemic.BMJ. 2021; 372: n614Google Scholar as well as reducing inequality. Several countries implemented safety protocols at schools, including the use of facemasks, hand hygiene, and staggered arrival and breaks. Regular testing9Paltiel AD Zheng A Walensky RP Assessment of SARS-CoV-2 screening strategies to permit the safe reopening of college campuses in the United States.JAMA Netw Open. 2020; 3e2016818Google Scholar, 10Bergstrom T Bergstrom CT Li H Frequency and accuracy of proactive testing for COVID-19.medRxiv. 2020; ( published online Sept 5.) ( preprint).https: //doi.org/10.1101/2020.09.05.20188839Google Scholar, 11Lasser J Sorger J Richter L Thurner S Schmid D Klimek P Assessing the impact of SARS-CoV-2 prevention measures in Austrian schools using agent-based simulations and cluster tracing data.Nat Commun. 2022; 13: 554Google Scholar, 12Leng T Hill EM Holmes A et al.Quantifying within-school SARS-CoV-2 transmission and the impact of lateral flow testing in secondary schools in England.medRxiv. 2021; ( published online July 16.) ( preprint).https: //doi.org/10.1101/2021.07.09.21260271Google Scholar was introduced in a few countries as an additional control measure. Vaccination was extended to the population aged 5 years and older in Europe, yet it was reported to have progressed slowly in the majority of countries as of January, 2022.13ECDCData on COVID-19 vaccination in the EU/EEA.https: //www.ecdc.europa.eu/en/publications-data/data-covid-19-vaccination-eu-eeaDate: Jan 31, 2022Date accessed: February 1, 2022Google Scholar School protocols were challenged by the rapid surge of cases due to the delta ( B.1.617.2) and omicron ( B.1.1.529) variants in the 2021–22 winter season in Europe,14ECDCAssessment of the further spread and potential impact of the SARS-CoV-2 omicron variant of concern in the EU/EEA, 19th update.https: //www.ecdc.europa.eu/en/publications-data/covid-19-omicron-risk-assessment-further-emergence-and-potential-impactDate: Jan 27, 2022Date accessed: February 11, 2022Google Scholar threatening classroom safety. Assessing vaccination and protocols in schools is therefore key to maintaining schools open in light of a continuously evolving pandemic. Here, through an agent-based transmission model parameterised on empirical contacts at schools and fitted to field screening data in schools, we estimated the school-specific effective reproductive number ( R) of SARS-CoV-2. We then evaluated intervention protocols combining school closures and screening, under varying immunity profiles of the school population, and accounting for age-specific differences in susceptibility to infection, contagiousness, contact patterns, and vaccine effectiveness.
Research in contextEvidence before this studyWe searched PubMed, medRxiv, bioRxiv, and arXiv for articles in English published up to Dec 3, 2021, which had, in the title or abstract, the terms “ COVID-19 ”, “ testing ”, and “ schools ”. We found a total of 271 unique articles. 57 works were modelling papers on the spread of COVID-19, and of these 31 ( 54%) implemented agent-based models. However, very few integrated information from empirical contacts or considered the cost of school closures in terms of school-days lost by students. No study addressed the role of vaccination in children in the school setting or the interplay of adherence to screening with frequency of screening. Modelling studies reached a consensus on the fact that test turnaround time is more important than test sensitivity for efficient testing strategies.Added value of this studyGovernments around the world proposed school closures as a first measure to slow down viral spread; however, the need to safely keep schools open is arguably a primary objective for educational, mental health, and socioeconomic reasons. Using empirical contact data collected in a primary school and a secondary school and data on test results collected in pilot screenings during the 2021 spring wave of the alpha variant in France, we estimated the effective reproductive number specific to each school setting in that period and showed that transmission was higher in schools than in the community. Accounting for the transmission advantage of the delta variant and vaccination coverage in Europe as of mid-September, 2021, we showed the need for regularly testing a partly immunised school population to reduce the number of cases while limiting the number of student-days lost. In particular, we highlighted the importance of adherence to screening, showing that higher screening frequency is needed to compensate for lower adherence. Model estimates indicate that the low levels of adherence recorded in pilot screenings during the third wave would be insufficient to control viral circulation in the school population. Increasing vaccination coverage in teachers did not impact potential outbreaks, mainly due to the large mixing among students. Regular testing would still provide a key benefit in decreasing viral circulation in a moderately vaccinated student population, or under waned protection against infection, and it would be especially important under the high-incidence conditions observed in the omicron wave.Implications of all the available evidenceBy studying different epidemic contexts and vaccination conditions, we provided a range of alternatives to school closure, to be implemented according to the epidemic activity and the reported adherence. These strategies become particularly important as the safety and normal functioning of classrooms are threatened by high community transmission rates. These results can inform national education systems to safely keep schools open while avoiding unnecessary closures.
We searched PubMed, medRxiv, bioRxiv, and arXiv for articles in English published up to Dec 3, 2021, which had, in the title or abstract, the terms “ COVID-19 ”, “ testing ”, and “ schools ”. We found a total of 271 unique articles. 57 works were modelling papers on the spread of COVID-19, and of these 31 ( 54%) implemented agent-based models. However, very few integrated information from empirical contacts or considered the cost of school closures in terms of school-days lost by students. No study addressed the role of vaccination in children in the school setting or the interplay of adherence to screening with frequency of screening. Modelling studies reached a consensus on the fact that test turnaround time is more important than test sensitivity for efficient testing strategies.
Governments around the world proposed school closures as a first measure to slow down viral spread; however, the need to safely keep schools open is arguably a primary objective for educational, mental health, and socioeconomic reasons. Using empirical contact data collected in a primary school and a secondary school and data on test results collected in pilot screenings during the 2021 spring wave of the alpha variant in France, we estimated the effective reproductive number specific to each school setting in that period and showed that transmission was higher in schools than in the community. Accounting for the transmission advantage of the delta variant and vaccination coverage in Europe as of mid-September, 2021, we showed the need for regularly testing a partly immunised school population to reduce the number of cases while limiting the number of student-days lost. In particular, we highlighted the importance of adherence to screening, showing that higher screening frequency is needed to compensate for lower adherence. Model estimates indicate that the low levels of adherence recorded in pilot screenings during the third wave would be insufficient to control viral circulation in the school population. Increasing vaccination coverage in teachers did not impact potential outbreaks, mainly due to the large mixing among students. Regular testing would still provide a key benefit in decreasing viral circulation in a moderately vaccinated student population, or under waned protection against infection, and it would be especially important under the high-incidence conditions observed in the omicron wave.
By studying different epidemic contexts and vaccination conditions, we provided a range of alternatives to school closure, to be implemented according to the epidemic activity and the reported adherence. These strategies become particularly important as the safety and normal functioning of classrooms are threatened by high community transmission rates. These results can inform national education systems to safely keep schools open while avoiding unnecessary closures.
Findings from this work informed the recommendations of the French National Immunisation Technical Advisory Group ( Haute Autorité de Santé) on vaccination of children in December, 2021.
We used empirical data describing time-resolved, face-to-face proximity contacts between individuals in two educational settings, collected in France using wearable radio frequency identification ( RFID) sensors before the pandemic. The primary school dataset describes contacts among 232 students ( aged 6–11 years) and ten teachers in a primary school in Lyon in October, 2009; the primary school was composed of five grades, each containing two classes.15Stehlé J Voirin N Barrat A et al.High-resolution measurements of face-to-face contact patterns in a primary school.PLoS One. 2011; 6e23176Google Scholar The secondary school dataset describes contacts among 325 students ( aged 17–18 years) of nine classes in a secondary school in Marseille in December, 2013.16Mastrandrea R Fournet J Barrat A Contact patterns in a high school: a comparison between data collected using wearable sensors, contact diaries and friendship surveys.PLoS One. 2015; 10e0136497Google Scholar Classes in the secondary school belonged to the second year of classes préparatoires, which is specific to the French schooling system for preparing students for University entry, and were divided into three groups based on the specialisation ( mathematics and physics; physics, chemistry, and engineering studies; and biology).
We built temporal contact networks, composed of nodes representing individuals ( classified by class and student or teacher) and links representing empirically measured proximity contacts occurring at a given time ( appendix p 14). As each dataset covers only a few days, we developed an approach to temporally extend the datasets by generating synthetic networks of contacts that reproduce the main features observed empirically ( class structure, within-class vs between-class links, contact duration heterogeneity, and similarity across days; appendix pp 14–18). The secondary school synthetic network was further extended to generate a synthetic first year ( to consider the full curriculum of the classes préparatoires), including teachers whose contacts were inferred from an additional dataset for the same school. The resulting network for the secondary school was composed of 650 students and 18 teachers.
In response to a rising third wave of SARS-CoV-2 in France in March, 2021, due to the alpha variant ( B.1.1.7), local authorities in the Auvergne-Rhône-Alpes region proposed pilot screenings at schools on a voluntary basis to detect cases. We used data on adherence to screening and test results collected in 683 schools between March 8 and June 7, 2021 ( weeks 10–23), in the Ain, Loire, and Rhône departments of the region ( figure 1E). Screening was interrupted in April due to reactive school closure ( week 14) and the Easter holidays ( weeks 15–16) while the country underwent the third national lockdown; it was resumed in week 17 at school reopening ( week 18 for secondary schools; figure 1G). Screenings involved 94 pre-schools ( ages 3–5 years), 427 primary schools ( ages 6–11 years), 158 middle schools ( ages 12–15 years), and four high schools ( ages 16–18 years), for a total of 209 564 students and 18 019 staff and teachers tested. PCR tests on saliva samples were proposed in pre-schools and primary schools and anterior nasal lateral flow device ( LFD) tests in middle and high schools. More details on the number of participating schools by department and over time, and on the observed adherence to testing, are provided in the appendix ( pp 19–22).
Contact studies were approved by the Commission Nationale de l'Informatique et des Libertés ( the French national body responsible for ethics and privacy; 1719527 and 1427054) and school authorities. Informed consent was obtained from participants or their parents if they were minors ( age < 18 years). No personal information of participants was associated with the RFID identifier. Testing at school was part of surveillance activities approved by school authorities and proposed with parental consent. Screening data were provided in aggregated and anonymised form.
We developed a stochastic agent-based model of SARS-CoV-2 transmission on the network of contacts. Infection progression includes prodromic transmission, followed by clinical or subclinical disease stages, informed from empirical distributions. Transmission occurs with a given transmissibility ( β) per contact per unit time between an infectious individual and a susceptible one. β was inferred by fitting the model to data from screening results during the 2021 spring wave. Individuals in the asymptomatic compartments were considered less infectious than individuals in the symptomatic compartments and to remain undocumented unless tested; 17Qiu X Nergiz AI Maraolo AE Bogoch II Low N Cevik M The role of asymptomatic and pre-symptomatic infection in SARS-CoV-2 transmission—a living systematic review.Clin Microbiol Infect. 2021; 27: 511-519Google Scholar a sensitivity analysis was performed on the value of the reduced transmissibility in the asymptomatic stage.
The model was parameterised with age-specific estimates of susceptibility, transmissibility, probability of developing symptoms, and probability to detect a case based on symptoms ( appendix pp 4–6). A systematic review4Viner RM Mytton OT Bonell C et al.Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis.JAMA Pediatrics. 2021; 175: 143Google Scholar indicated that children ( younger than 10–14 years) have lower susceptibility to SARS-CoV-2 than adults, but building evidence suggests that adolescents ( older than 10–12 years) might be as susceptible as adults ( ≥20 years).4Viner RM Mytton OT Bonell C et al.Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis.JAMA Pediatrics. 2021; 175: 143Google Scholar, 18Thompson HA Mousa A Dighe A et al.Severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2) setting-specific transmission rates: a systematic review and meta-analysis.Clin Infect Dis. 2021; 73: e754-e764Google Scholar Here, we considered a relative susceptibility of 50% in primary school children and 75% in secondary school adolescents compared with adults for the main analysis and 100% susceptibility in adolescents in a sensitivity analysis. The probability of recognising a suspected SARS-CoV-2 infection from symptoms was set to 30% for children and 50% for adolescents and adults on the basis of studies indicating that about two-thirds of symptomatic children3Han MS Choi EH Chang SH et al.Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea.JAMA Pediatrics. 2021; 175: 73Google Scholar and half of symptomatic adults19Smith LE Potts HWW Amlôt R Fear NT Michie S Rubin GJ Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys.BMJ. 2021; 372: n608Google Scholar have unrecognised symptoms before diagnosis. These values were varied in sensitivity analyses ( appendix pp 9, 51). We considered a relative transmissibility of 63% in children compared with adults as evidence suggests that transmission in children might be less efficient than in adults,20Dattner I Goldberg Y Katriel G et al.The role of children in the spread of COVID-19: using household data from Bnei Brak, Israel, to estimate the relative susceptibility and infectivity of children.PLoS Comput Biol. 2021; 17e1008559Google Scholar and we tested 80% relative transmissibility in a sensitivity analysis.
The model was further stratified to account for vaccination status and to include vaccine effectiveness against infection, transmission, and clinical symptoms given infection21Tartof SY Slezak JM Fischer H et al.Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study.Lancet. 2021; 398: 1407-1416Google Scholar ( appendix pp 9–12). Higher and lower values for vaccine effectiveness were tested in sensitivity analyses. Full details on the transmission model are reported in the appendix ( pp 4–13).
Symptom-based testing and case isolation was considered the basic strategy, present in all protocols, and against which interventions were evaluated. Under the basic strategy, confirmed cases isolate for 7 days. In addition to the basic strategy, we considered several intervention protocols. First, we considered a protocol of reactive quarantine of the class, wherein once a case is identified through symptom-based testing their class is closed and put into quarantine for 7 days. If quarantined individuals develop symptoms, they remain in isolation for an additional 7 days before returning to school. This protocol was largely adopted in France before the delta wave in November, 2021. The second protocol was reactive quarantine of the class level or specialisation, which is similar to the reactive quarantine of the class protocol except that quarantine is applied to the classes of the same level ( two classes in the primary school) or specialisation ( three in the secondary school) of the detected case. This option was considered as empirical data showed a larger mixing between students of the same level or specialisation than between students of different levels or specialisations.15Stehlé J Voirin N Barrat A et al.High-resolution measurements of face-to-face contact patterns in a primary school.PLoS One. 2011; 6e23176Google Scholar, 16Mastrandrea R Fournet J Barrat A Contact patterns in a high school: a comparison between data collected using wearable sensors, contact diaries and friendship surveys.PLoS One. 2015; 10e0136497Google Scholar Third, we considered reactive screening of the entire class on the day after detection of the case by symptom-based testing, followed by a control screening on days 4 or 7 after case identification to detect previously undetected cases. This protocol assumes that 100% of the non-vaccinated school population adheres to screening. This protocol was adopted in France during the delta wave. Fourth, we considered regular testing of the entire school once every 2 weeks or once or twice a week, in addition to symptom-based testing, with adherence among the non-vaccinated informed by field data and further explored in a range between 10% and 100%. Finally, we considered a protocol of regular testing with different levels of adherence among the non-vaccinated and reactive closure of the class triggered at every detected case.
Following protocols adopted in France, we assumed testing consisted of PCR tests on saliva samples for primary schools and anterior nasal LFD tests for secondary schools, with time-varying test sensitivity specific to each test and results available after 24 h for PCR and after 15 min for LFD tests ( appendix pp 7–8). Teachers are required to show proof of a negative PCR test when returning to school after infection.
We used data on test results collected in the pilot screenings during the 2021 spring wave in the Ain, Loire, and Rhône departments to estimate the transmissibility per contact per unit time of the alpha variant ( βalpha) and the corresponding school-specific R for the alpha variant ( Ralpha) in that period. The model was fitted to the observed prevalence of cases in students in the tested schools through a maximum likelihood approach. We used data from screenings performed during the rise of the spring wave ( March 8 to April 2, 2021) that involved at least five schools and 500 screened students per week per department for each school type ( primary or secondary) and with reported adherence to screening of at least 50% ( reference inclusion criteria). In sensitivity analyses, we relaxed the constraint on adherence ( sensitivity inclusion criteria). Simulations for the fit covered the period from week 8 ( starting Feb 22, 2021, at school reopening after winter holidays) to week 13 ( ending April 4) before the reactive school closure, and they were initialised with age-specific seroprevalence estimates.22Santé publique FranceCOVID-19: études pour suivre la part de la population infectée par le SARS-CoV-2 en France.https: //www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/articles/covid-19-une-etude-pour-connaitre-la-part-de-la-population-infectee-par-le-coronavirus-en-franceDate: April 22, 2020Date accessed: October 10, 2021Google Scholar Weekly introductions at school were modelled stochastically, inferred from age-specific community surveillance data, and adjusted to account for detection rate and within-school transmission.23Mercer GN Glass K Becker NG Effective reproduction numbers are commonly overestimated early in a disease outbreak.Stat Med. 2011; 30: 984-994Google Scholar We computed R in each school as the ratio of the number of individuals infected at the second generation to the number infected at the first generation for each initial seed over 5000 simulated outbreaks. The estimated R refers to the reactive quarantine of the class protocol with a facemask mandate applied in that period. Full details on the procedure are reported in the appendix ( pp 23–29).
To evaluate the efficacy of intervention protocols, we considered a 2021–22 winter scenario due to the delta variant, initialised with 25% natural immunity in the population, 60% of teachers vaccinated, and 40% of adolescents vaccinated, corresponding to the median vaccination coverage registered in countries in Europe by mid-September, 2021 ( appendix p 31). The transmissibility per contact per unit time for the delta variant ( βdelta) was estimated from the maximum likelihood estimate βMLE=βalpha, accounting for the transmissibility advantage of the delta variant.24Alizon S Haim-Boukobza S Foulongne V et al.Rapid spread of the SARS-CoV-2 delta variant in some French regions, June 2021.Euro Surveill. 2021; 262100573Google Scholar The corresponding school-specific R for the delta variant ( Rdelta) was estimated from simulated outbreaks under the above immunity conditions, and considering the reactive quarantine of the class protocol with facemasks mandated. We additionally explored a range of Rdelta values to account for the uncertainty in the estimate of delta transmissibility,24Alizon S Haim-Boukobza S Foulongne V et al.Rapid spread of the SARS-CoV-2 delta variant in some French regions, June 2021.Euro Surveill. 2021; 262100573Google Scholar seasonal effects,25Collin A Hejblum BP Vignals C et al.Using population based Kalman estimator to model COVID-19 epidemic in France: estimating the effects of non-pharmaceutical interventions on the dynamics of epidemic.medRxiv. 2021; ( published online July 16.) ( preprint).https: //doi.org/10.1101/2021.07.09.21260259Google Scholar and variations in βMLE due to the inclusion criteria considered in the inference. We considered low, moderate, sustained, and high weekly introductions modelled stochastically and corresponding to community surveillance incidence in primary school students ranging in time from 25 to more than 600 cases per 100 000 ( low introductions), from 50 to 900 cases per 100 000 ( moderate), from 100 to 1300 cases per 100 000 ( sustained), and from 200 to 1800 cases per 100 000 ( high); values for the secondary school are reported in the appendix ( p 33).
To assess the efficacy of screening protocols under different immunity conditions, we explored a full range of vaccination coverage in children, adolescents, and teachers.
We considered the circulation of the highly transmissible and immune-evasive omicron variant that became dominant in Europe by the start of 2022.14ECDCAssessment of the further spread and potential impact of the SARS-CoV-2 omicron variant of concern in the EU/EEA, 19th update.https: //www.ecdc.europa.eu/en/publications-data/covid-19-omicron-risk-assessment-further-emergence-and-potential-impactDate: Jan 27, 2022Date accessed: February 11, 2022Google Scholar We tested the efficacy of school protocols under the high-incidence conditions registered in France by mid-January, 2022 ( 5500 cases per 100 000 children aged 6–10 years). Details of this analysis are reported in the appendix ( p 37).
Estimates for β and R were obtained from 5000 simulated stochastic outbreaks for each parameter set. Estimates for R were compared with the age-specific, time-varying reproductive number ( Rt), estimated from community surveillance data, with a one-sample t-test. We fitted the predicted offspring distribution to a negative binomial to estimate the overdispersion parameter k.26Adam DC Wu P Wong JY et al.Clustering and superspreading potential of SARS-CoV-2 infections in Hong Kong.Nat Med. 2020; 26: 1714-1719Google Scholar In the analysis of closure and screening protocols, we performed 1000 stochastic runs for the primary school and 2000 for the secondary school for each parameter set, over the course of a trimester ( 90 days). We computed medians and 95% bootstrap CIs from simulation outputs to compare protocols with a Mood's median test. IQRs were used to describe observed adherence. Network statistics in the primary and secondary schools were compared with a Student's t-test. We used R software version 4.1.1 for the statistical analyses.
The funders had no role in study design, data collection, data analysis, data interpretation, writing of the manuscript, or the decision to submit for publication.
Contact networks measured through wearable sensors displayed a strong community structure around the classes, common to both the primary and secondary schools ( appendix p 14). The patterns of interaction, however, varied substantially between the two settings. On average, children had a larger number of distinct contacts during a day than adolescents, interacting with almost their entire class ( 83% vs 33% of the class, Student's t-test p < 0·0001; figure 1B). Approximately 50% more links occurred between classes than within classes in the primary school ( 28 vs 19 links, p < 0·0001), whereas in adolescents, 75% fewer links occurred between than within classes ( three vs 12 links, p < 0·0001). After accounting for duration, students in both settings spent on average more time interacting within the class than outside the class ( p < 0·0001; figure 1C) and established longer contacts than teachers ( 64% longer, p=0·009; figure 1D).
Using the empirical contact patterns, we inferred the school-specific transmissibility from screening data in primary schools that satisfied the inclusion criteria: 71 primary schools with 12 146 tested students met the reference inclusion criteria, and 103 primary schools with 15 916 tested students met the sensitivity inclusion criteria. Secondary schools were excluded because of limited participation, but with βMLE we could estimate the within-school Ralpha both in the primary school and in the secondary school. We estimated that Ralpha during the 2021 spring wave of the alpha variant in France when reactive class closures and facemask mandates were in place was 1·40 ( 95% CI 1·35–1·45) in primary schools that met the reference inclusion criteria, 1·44 ( 1·40–1·48) in primary schools that met the sensitivity inclusion criteria, 1·46 ( 1·41–1·51) in secondary schools that met the reference inclusion criteria, and 1·50 ( 1·46–1·54) in secondary schools that met the sensitivity inclusion criteria ( figure 2A). Estimates were higher than the Rt obtained from age-specific community surveillance in the same period ( one-sample t-test p < 0·0001 in the primary and secondary school; figure 2C). We quantified a large individual-level variation in SARS-CoV-2 transmission in both schools, corresponding to an estimated overdispersion parameter k of 0·56 ( 95% CI 0·49–0·63) in the primary school and 0·52 ( 0·46–0·58) in the secondary school ( figure 2B). Accounting for the transmissibility advantage of the delta variant and vaccination coverage in Europe, we estimated a school-specific Rdelta of 1·66 ( 95% CI 1·60–1·71) for primary schools that met the reference inclusion criteria, 1·70 ( 1·66–1·75) for primary schools that met the sensitivity inclusion criteria, 1·10 ( 1·06–1·14) for secondary schools that met the reference inclusion criteria, and 1·13 ( 1·10–1·16) in secondary schools that met the sensitivity inclusion criteria. In the analysis of closure and screening protocols, we used the Rdelta estimate obtained with the reference inclusion criteria, and explored ranges for Rdelta of 1·46–2·00 in primary schools and 0·97–1·34 in secondary schools to account for the uncertainty associated with delta transmissibility, seasonal effects, and sensitivity inclusion criteria.Figure 2Estimates of R in the school setting during the 2021 spring wave in France due to the alpha variantShow full caption ( A) Estimates of R in primary and secondary schools obtained with the reference and the sensitivity inclusion criteria by fitting the model to pilot screening data; estimates refer to the alpha variant during the 2021 spring wave in France, when reactive closure of classes and facemask mandates were in place, and error bars indicate 95% CIs. ( B) Predicted offspring distribution in primary and secondary schools; bold vertical lines indicate R ( ie, the average of the distribution) obtained with the reference inclusion criteria. ( C) Comparison between the estimate of R for the alpha variant ( bold horizontal line; the shaded area corresponds to its 95% CI) and Rt estimated from community surveillance in the Ain, Loire, and Rhône departments during the rise of the 2021 spring wave for primary schools and secondary schools. MLE=maximum likelihood estimate. R=effective reproductive number. Rt=time-varying reproductive number.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Estimates of R in primary and secondary schools obtained with the reference and the sensitivity inclusion criteria by fitting the model to pilot screening data; estimates refer to the alpha variant during the 2021 spring wave in France, when reactive closure of classes and facemask mandates were in place, and error bars indicate 95% CIs. ( B) Predicted offspring distribution in primary and secondary schools; bold vertical lines indicate R ( ie, the average of the distribution) obtained with the reference inclusion criteria. ( C) Comparison between the estimate of R for the alpha variant ( bold horizontal line; the shaded area corresponds to its 95% CI) and Rt estimated from community surveillance in the Ain, Loire, and Rhône departments during the rise of the 2021 spring wave for primary schools and secondary schools. MLE=maximum likelihood estimate. R=effective reproductive number. Rt=time-varying reproductive number.
Under the estimated delta transmissibility and with sustained introductions, regular testing constitutes an efficient protocol for preventing infections in a partially immunised school population ( figure 3A). If adherence among the non-vaccinated is large enough, regular testing can substantially outperform protocols based on simply identifying cases given recognisable symptoms and additionally closing or screening the class of the detected case ( even with a follow-up control screening). However, screenings at schools during the 2021 spring wave in France were met with low or moderate participation rates. Adherence was higher in lower school levels ( 39% [ IQR 26–49 ] in pre-school and 53% [ 43–65 ] in primary school) than in secondary schools ( 10% [ 5–17 ] in middle school and 6% [ 3–10 ] in high school; Mood's median test p < 0·0001; figure 1F). We found that with 50% adherence among the non-vaccinated—ie, approximately the value recorded in the French primary schools—weekly screening would reduce the number of cases by 21% ( 95% CI 19–23) in primary schools and 26% ( 24–28) in secondary schools compared with symptom-based testing alone. Case reduction would rise to 34% ( 32–36) and 36% ( 35–39) in primary and secondary schools, respectively, with 75% adherence. Alternatively, similar reductions would be achieved with 50% adherence and twice-weekly testing. These data show how infection prevention improves with both adherence and frequency of tests, and higher frequency is needed to compensate for lower adherence. However, if adherence to regular testing is too low ( 10%), as recorded in the French secondary schools, weekly testing would have little impact ( < 10% case reduction, similar to reactive screening and lower than reactive closure). Although trends are similar across settings, partial vaccination coverage in adolescents leads to smaller epidemic sizes in the secondary school than in the primary school ( relative to the school size; figure 3B; appendix p 41).Figure 3Efficiency of regular testing in educational environmentsShow full caption ( A) Predicted case reduction relative to symptom-based testing alone in primary schools and secondary schools; the reduction is computed on the final epidemic size over 90 days. Error bars correspond to 95% bootstrap CIs ( in some cases smaller than the symbol size). The empty marker corresponds to the adherence estimated from empirical data. ( B) Probability distribution of the simulated epidemic size over 90 days in the primary school and secondary school for selected protocols ( regular testing is performed weekly). C) Probability distribution of the additional number of classes in the primary school and secondary school with at least one active infection when a case is confirmed, for selected protocols ( regular testing is performed weekly). In all panels, simulations are parameterised with sustained introductions and the estimated effective reproductive number for the delta variant when reactive class closures and facemask mandates are in place, and accounting for differences in vaccination coverage. * All protocols involve symptom-based testing. †Reactive screening of the class is done on the day after detection of the case, followed by a control screening on day 4 after case identification, with 100% adherence among the non-vaccinated. ‡Regular testing is performed with one test every 1 week ( medium-sized circle) or 2 weeks ( smallest circle) or two tests per week ( largest circle).View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Predicted case reduction relative to symptom-based testing alone in primary schools and secondary schools; the reduction is computed on the final epidemic size over 90 days. Error bars correspond to 95% bootstrap CIs ( in some cases smaller than the symbol size). The empty marker corresponds to the adherence estimated from empirical data. ( B) Probability distribution of the simulated epidemic size over 90 days in the primary school and secondary school for selected protocols ( regular testing is performed weekly). C) Probability distribution of the additional number of classes in the primary school and secondary school with at least one active infection when a case is confirmed, for selected protocols ( regular testing is performed weekly). In all panels, simulations are parameterised with sustained introductions and the estimated effective reproductive number for the delta variant when reactive class closures and facemask mandates are in place, and accounting for differences in vaccination coverage. * All protocols involve symptom-based testing. †Reactive screening of the class is done on the day after detection of the case, followed by a control screening on day 4 after case identification, with 100% adherence among the non-vaccinated. ‡Regular testing is performed with one test every 1 week ( medium-sized circle) or 2 weeks ( smallest circle) or two tests per week ( largest circle).
As well as reducing the number of infections, regular testing is predicted to strongly limit the number of days of absence of students. Quarantine of the class leads to 17·7 ( 95% CI 17·4–17·9) and 32·6 ( 31·9–33·5) times more student-days lost in primary and secondary schools, respectively, than when symptom-based testing is used alone ( figure 4A). Days lost inevitably increase when reactive closure is extended to classes of the same level or specialisation. Not being sufficiently targeted, reactive closure quarantines individuals while their risk of infection might be low, and the virus might have spread to other classes ( figure 3C). Reducing mixing across classes through cohorting improves control ( appendix p 44). Despite detecting more cases, regular testing leads to a small increase in student-days lost, less than 6·6 ( 6·4–6·8) times the number of days lost with the basic strategy and about 63–80% less than reactive class closure as isolation is applied only to detected cases. The cost–benefit analysis shows that for all regular testing strategies, the cost expressed as student-days lost remains low, even when the benefit becomes high, for a range of different epidemic conditions ( figure 4B). Strategies based on class closures do not reach substantial benefit, even at large costs. Reactive screening limits days lost but with a negligible impact on viral circulation. Closing the class at each case detected by regular testing improves case reduction but at the cost of increased absence from school ( appendix p 43). Findings were robust to changes in detection rates and test sensitivity ( appendix pp 51–52).Figure 4Cost–benefit analysis of regular testing in educational environments and the impact of introductions and RShow full caption ( A) Predicted increase in student-days lost relative to symptom-based testing alone. Regular testing is performed weekly. Simulations are parameterised with sustained introductions and the estimated Rdelta when reactive class closures and facemask mandates are in place, accounting for differences in vaccination coverage. ( B) Predicted case reduction versus predicted increase in student-days lost in the primary school ( R 1·46–2·00) and secondary school ( R 0·97–1·34) for each protocol relative to symptom-based testing only. Regular testing is performed weekly. Simulations are parameterised with sustained introductions. ( C) Predicted case reduction relative to symptom-based testing only for selected protocols ( regular testing is performed weekly) as a function of the level of introductions; simulations are parameterised with the estimated Rdelta. ( D) Predicted case reduction relative to symptom-based testing alone for selected protocols in the primary school and secondary school as a function of R. Regular testing involves weekly screening unless otherwise indicated. Simulations are parameterised with sustained introductions. All protocols involve symptom-based testing. R=effective reproductive number. Rdelta=effective reproductive number for the delta variant. * Reactive screening of the class is done on the day after detection of the case, followed by a control screening on day 4 after case identification, with 100% adherence among the non-vaccinated.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Predicted increase in student-days lost relative to symptom-based testing alone. Regular testing is performed weekly. Simulations are parameterised with sustained introductions and the estimated Rdelta when reactive class closures and facemask mandates are in place, accounting for differences in vaccination coverage. ( B) Predicted case reduction versus predicted increase in student-days lost in the primary school ( R 1·46–2·00) and secondary school ( R 0·97–1·34) for each protocol relative to symptom-based testing only. Regular testing is performed weekly. Simulations are parameterised with sustained introductions. ( C) Predicted case reduction relative to symptom-based testing only for selected protocols ( regular testing is performed weekly) as a function of the level of introductions; simulations are parameterised with the estimated Rdelta. ( D) Predicted case reduction relative to symptom-based testing alone for selected protocols in the primary school and secondary school as a function of R. Regular testing involves weekly screening unless otherwise indicated. Simulations are parameterised with sustained introductions. All protocols involve symptom-based testing. R=effective reproductive number. Rdelta=effective reproductive number for the delta variant. * Reactive screening of the class is done on the day after detection of the case, followed by a control screening on day 4 after case identification, with 100% adherence among the non-vaccinated.
Higher incidence in the community ( increasing the expected introductions at school) and larger values for R ( increasing within-school transmission) reduce the benefit of weekly testing in primary schools, thus requiring increased adherence or frequency ( figure 4C, D). The impact of introductions is milder in the secondary school than in the primary school due to vaccination of adolescents ( figure 4D). Moreover, increasing R in this setting would increase the benefit of regular testing, contrary to the primary school case. This is due to a bell-shaped dependence of the infection prevention capacity of regular testing versus R ( appendix p 46): in low-transmission conditions, only a few cases are present even under the scenario of symptom-based testing and case isolation, so that additional protocols yield marginal benefit; as transmission increases from small values ( the secondary school case, where R is small thanks to vaccination), efficiency increases. In high-transmission conditions, case prevention is hindered by too many infections generated between successive screenings, and efficiency decreases as transmission increases ( the primary school case, with high R because of unvaccinated children). Changes in epidemiological parameters ( transmissibility and susceptibility) yield changes in R and consequently in protocols ' efficiencies, but protocols ' ranking according to their benefit remains robust ( appendix pp 48–50). High-incidence conditions due to immune evasion and higher transmissibility, compatible with an omicron scenario, confirm the value of screening with high frequency ( appendix p 37).
Benefits and costs of regular testing remain stable when vaccination coverage of teachers increases from 60% to 100% ( figure 5A; appendix pp 41). Increasing vaccination coverage in students, both in primary and secondary schools, is a strong protective factor against school outbreaks ( figure 5B–D), and compared with no vaccination, is expected to reduce the epidemic size by 38% ( 95% CI 36–40) with 20% coverage and by 75% ( 74–76) with 50% coverage in children under the basic protocol, considering vaccine effectiveness before waning occurs with time ( figure 5D, appendix p 40). Regular testing would provide an important supplementary control, especially while rolling out vaccination campaigns in primary schools: weekly screening 75% of non-vaccinated students would additionally reduce cases compared with the basic protocol by 36% ( 95% CI 32–39) with 20% vaccination coverage in children, and by 23% ( 20–26) with 50% coverage, without impacting student-days lost ( figure 5E). Similar results are obtained with lower vaccine effectiveness ( appendix p 54). The minimum vaccination coverage to reduce the benefit of regular testing to 20% case reduction or below increases with R; for R between 1·6 and 2·0, the required coverage stabilises at around 55–60% ( figure 5F).Figure 5Impact of vaccination coverage on case reduction, epidemic size, and student-days lostShow full caption ( A) Predicted case reduction relative to symptom-based testing alone for selected protocols as a function of the vaccination coverage in teachers in the primary school. ( B) Predicted case reduction relative to symptom-based testing alone for selected protocols as a function of vaccination coverage in children in the primary school. ( C) Predicted case reduction relative to symptom-based testing alone for selected protocols as a function of vaccination coverage inç adolescents in the secondary school. ( D) Predicted final epidemic size over 90 days versus vaccination coverage in children in the primary school for selected protocols. ( E) Predicted increase in student-days lost relative to symptom-based testing alone for selected protocols as a function of the vaccination coverage in children in the primary school. ( F) Minimal vaccination coverage in children above which regular testing with 75% adherence among the non-vaccinated in the primary school has at most a benefit of 20% case reduction, as a function of R. In all panels, simulations are parameterised with sustained introductions, all protocols include symptom-based testing, and regular testing is performed weekly. R=effective reproductive number.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Predicted case reduction relative to symptom-based testing alone for selected protocols as a function of the vaccination coverage in teachers in the primary school. ( B) Predicted case reduction relative to symptom-based testing alone for selected protocols as a function of vaccination coverage in children in the primary school. ( C) Predicted case reduction relative to symptom-based testing alone for selected protocols as a function of vaccination coverage inç adolescents in the secondary school. ( D) Predicted final epidemic size over 90 days versus vaccination coverage in children in the primary school for selected protocols. ( E) Predicted increase in student-days lost relative to symptom-based testing alone for selected protocols as a function of the vaccination coverage in children in the primary school. ( F) Minimal vaccination coverage in children above which regular testing with 75% adherence among the non-vaccinated in the primary school has at most a benefit of 20% case reduction, as a function of R. In all panels, simulations are parameterised with sustained introductions, all protocols include symptom-based testing, and regular testing is performed weekly. R=effective reproductive number.
Strategies to safely keep schools open during the COVID-19 pandemic are a matter of controversial debate, and knowledge from the field is scarce. Using screening data from schools during the 2021 spring wave in France and empirical contact data, our study provides the first estimate of SARS-CoV-2 transmissibility in different school settings, suggesting that contacts at school increase SARS-CoV-2 transmission potential compared with transmission in the community. With countries in Europe experiencing record-high cases due to the omicron variant,14ECDCAssessment of the further spread and potential impact of the SARS-CoV-2 omicron variant of concern in the EU/EEA, 19th update.https: //www.ecdc.europa.eu/en/publications-data/covid-19-omicron-risk-assessment-further-emergence-and-potential-impactDate: Jan 27, 2022Date accessed: February 11, 2022Google Scholar protocols at school remain a central issue as high community transmission leaves schools vulnerable and vaccination of children progresses slowly in most countries.13ECDCData on COVID-19 vaccination in the EU/EEA.https: //www.ecdc.europa.eu/en/publications-data/data-covid-19-vaccination-eu-eeaDate: Jan 31, 2022Date accessed: February 1, 2022Google Scholar Our analysis indicates that regularly screening the school population is efficient in preventing infections while reducing absence from school, especially in settings where the school population is not yet vaccinated, coverage is low to moderate, or vaccine protection has largely waned.
We estimated a higher transmissibility in the school than in the community during the 2021 spring wave of the alpha variant in France. This finding suggests that repeated contacts in dense classrooms, even with facemask mandates in place, except for during sport and at lunch, favour transmission in the absence of screening protocols, with potentially high overdispersion.26Adam DC Wu P Wong JY et al.Clustering and superspreading potential of SARS-CoV-2 infections in Hong Kong.Nat Med. 2020; 26: 1714-1719Google Scholar, 27Susswein Z Bansal S Characterizing superspreading of SARS-CoV-2: from mechanism to measurement.medRxiv. 2020; ( published online Dec 11.) ( preprint).https: //doi.org/10.1101/2020.12.08.20246082Google Scholar These findings align with available evidence of increased transmission in the population if schools are open.2Goldstein E Lipsitch M Cevik M On the effect of age on the transmission of SARS-CoV-2 in households, schools, and the community.J Infect Dis. 2021; 223: 362-369Google Scholar, 5Li Y Campbell H Kulkarni D et al.The temporal association of introducing and lifting non-pharmaceutical interventions with the time-varying reproduction number ( R) of SARS-CoV-2: a modelling study across 131 countries.Lancet Infect Dis. 2021; 21: 193-202Google Scholar In the absence of vaccination, secondary school students are predicted to infect on average a larger number of individuals than primary school students, consistent with previous observations,2Goldstein E Lipsitch M Cevik M On the effect of age on the transmission of SARS-CoV-2 in households, schools, and the community.J Infect Dis. 2021; 223: 362-369Google Scholar due to age-specific epidemiological properties and contact patterns. However, more contagious variants and limited vaccination coverage in children currently put them at higher risk compared with the rest of the population, which is partially protected by vaccination. A disproportionately higher omicron circulation has been observed in children than in the general population ( 5500 cases per 100 000 children aged 6–10 years vs 3000 per 100 000 population in all age classes in France by mid-January, 2022) that is further sustained by transmission at school, resulting in large school disruption,28Fregonara di G Più che raddoppiate le classi in Dad. Medie e superiori, si torna senza tampone. Corriere della Sera.https: //www.corriere.it/scuola/secondaria/22 gennaio 28/raddoppiano-classi-dad-20-cento-studenti-casa-81a371d0-802f-11ec-9fac-a85f17701932.shtmlDate: Jan 28, 2022Date accessed: February 1, 2022Google Scholar, 29Morin V Battaglia M Rof G et al.COVID-19: dans les écoles, la semaine de toutes les tensions. Le Monde.https: //www.lemonde.fr/education/article/2022/01/08/covid-19-dans-les-ecoles-la-semaine-de-toutes-les-tensions 6108656 1473685.htmlDate: Jan 8, 2022Date accessed: January 20, 2022Google Scholar a higher risk of infection for students ' household members,30Grant R Charmet T Schaeffer L et al.Impact of SARS-CoV-2 delta variant on incubation, transmission settings and vaccine effectiveness: results from a nationwide case-control study in France.Lancet Reg Health Eur. 2022; 13100278Google Scholar and rapid transmission in the community.31Li H Lin H Chen X et al.A need of COVID19 vaccination for children aged < 12 years: comparative evidence from the clinical characteristics in patients during a recent delta surge ( B.1.617.2).medRxiv. 2021; ( published online Nov 8.) ( preprint).https: //doi.org/10.1101/2021.11.05.21265712Google Scholar Even when conditions due to the circulating variant and vaccination coverage bring the school-specific R to below 1 ( eg, as estimated under a delta wave in secondary schools in France with 77% vaccinated adolescents and high vaccine effectiveness; appendix pp 35–36), the predicted highly overdispersed offspring distribution suggests that, together with highly likely extinctions, chains of transmissions in schools are relatively rare but possible.
Using the estimated school-specific transmission rate for delta and a range of realistic epidemic conditions ( with regard to introductions, seasonality, and vaccination coverage), we found that regular testing with large enough adherence provides an optimal balance in controlling school outbreaks while maintaining schools open. This finding is consistent with results showing that twice-weekly testing in England helped to control within-school transmission in secondary schools.12Leng T Hill EM Holmes A et al.Quantifying within-school SARS-CoV-2 transmission and the impact of lateral flow testing in secondary schools in England.medRxiv. 2021; ( published online July 16.) ( preprint).https: //doi.org/10.1101/2021.07.09.21260271Google Scholar Adherence is, however, critical, suggesting that at least three-quarters of non-vaccinated individuals should participate in weekly testing to achieve a considerable case reduction. This level of adherence was not achieved in the pilot screenings in early 2021 in France. Implementing regular testing should consider improving strategies for the communication and engagement of the school community to considerably boost participation and maintain it over time.
Our findings corroborate previous numerical evidence on the value of regular testing in preventing infections.9Paltiel AD Zheng A Walensky RP Assessment of SARS-CoV-2 screening strategies to permit the safe reopening of college campuses in the United States.JAMA Netw Open. 2020; 3e2016818Google Scholar, 10Bergstrom T Bergstrom CT Li H Frequency and accuracy of proactive testing for COVID-19.medRxiv. 2020; ( published online Sept 5.) ( preprint).https: //doi.org/10.1101/2020.09.05.20188839Google Scholar, 11Lasser J Sorger J Richter L Thurner S Schmid D Klimek P Assessing the impact of SARS-CoV-2 prevention measures in Austrian schools using agent-based simulations and cluster tracing data.Nat Commun. 2022; 13: 554Google Scholar Our study adds to previous work by estimating the school-specific R in primary and secondary schools and integrating empirical face-to-face proximity data, allowing us to quantify individual-level variation in SARS-CoV-2 transmission. It also provides a cost–benefit analysis considering successive variants, comparing multiple protocols, and evaluating the key role of adherence in the context of partly vaccinated school populations.
Reactive class closure is highly costly in terms of student-days lost, even though detecting a case is rarer in children than in adults. Countries adopting this strategy during the omicron wave registered record-high absenteeism from school ( 20% of students were in remote learning in Italy in January, 202228Fregonara di G Più che raddoppiate le classi in Dad. Medie e superiori, si torna senza tampone. Corriere della Sera.https: //www.corriere.it/scuola/secondaria/22 gennaio 28/raddoppiano-classi-dad-20-cento-studenti-casa-81a371d0-802f-11ec-9fac-a85f17701932.shtmlDate: Jan 28, 2022Date accessed: February 1, 2022Google Scholar). It also has a limited value in epidemic control, as other classes might be already affected due to unobserved introductions from the community or silent spreading within the school. The effect of silent spreading becomes particularly important when between-classes mixing is higher, as observed in the primary school. Cohorting that reduces contacts between classes is therefore an important component of school protocols, in support to screening. While regular testing detects more cases than symptom-based detection, it keeps days lost low for two main reasons. First, isolation is only applied to cases during their infectious period, being therefore more targeted than class quarantine. Second, detecting cases that otherwise go unnoticed helps control the epidemic, breaking the chains of transmission and preventing further diffusion. As a consequence, the overall time spent in isolation is also reduced. Reactive screening, instead, would leave many cases undetected even when retesting a few days after. The iterative nature of regular testing is key to ensure control over time.
Our analysis on the omicron wave ( appendix p 37) confirms the large benefit of regularly screening students compared with reactive strategies, even when these strategies are strengthened, for example, by increasing the number of reactive screenings following the index case. The reinforced reactive protocol adopted in France at the reopening of schools in January, 2022, required three screenings to be performed at days 0, 2, and 4 from detection. But under the high omicron incidence experienced at the start of 2022, this protocol led to an unprecedented demand in tests, impacting logistics, available resources, and surveillance capacity.29Morin V Battaglia M Rof G et al.COVID-19: dans les écoles, la semaine de toutes les tensions. Le Monde.https: //www.lemonde.fr/education/article/2022/01/08/covid-19-dans-les-ecoles-la-semaine-de-toutes-les-tensions 6108656 1473685.htmlDate: Jan 8, 2022Date accessed: January 20, 2022Google Scholar Our findings support instead strengthening regular screening by increasing adherence and adjusting frequency to local incidence and policy expectations, next to cohorting, facemask use, and ventilation.
Increasing vaccination in teachers protects them from infection and symptomatic disease21Tartof SY Slezak JM Fischer H et al.Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study.Lancet. 2021; 398: 1407-1416Google Scholar but yields limited protection for the school population, even under full coverage. This results from the small number of teachers and the observed lower rate of interaction they have with students, and it is confirmed even when community incidence in adults is much higher than in the student-age classes. Extending vaccination to students is needed to achieve a collective benefit, reducing the likelihood and size of school outbreaks with active vaccination protection. In these conditions, regular testing would bring a supplementary control whose application should be evaluated in light of resources, logistics, adherence, epidemic conditions, and waning of vaccine effectiveness. Regular testing remains, however, critical in moderate ( or lower) coverage situations, or when protection against infection has waned, as it would prevent a substantial proportion of undetected infections, having a direct impact on the school environment, reducing the number of infections and long-COVID in children,32Office for National StatisticsPrevalence of ongoing symptoms following coronavirus ( COVID-19) infection in the UK: 1 April 2021.https: //www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/1april2021 # prevalence-of-ongoing-symptoms-following-coronavirus-infection-in-the-uk-dataDate: 2021Date accessed: August 9, 2021Google Scholar and an indirect impact on the community, protecting students ' contacts.30Grant R Charmet T Schaeffer L et al.Impact of SARS-CoV-2 delta variant on incubation, transmission settings and vaccine effectiveness: results from a nationwide case-control study in France.Lancet Reg Health Eur. 2022; 13100278Google Scholar
This study has limitations. First, it focuses on two school settings for which empirical contact data were available, but contacts in other schools might be different, depending on the structure of curricula and the organisation of activities. Findings on the efficiency of regular testing and vaccination are, however, robust across a range of epidemic conditions and synthetic contact patterns and can thus inform on the choice of strategies to safely keep schools open. Second, data availability for the inference was limited by the pilot screening. Further work could also focus on the downward phase of the alpha wave. Third, the study focuses on school outbreaks and it does not assess the impact that these strategies will have on the viral circulation in the community. Fourth, we did not model waning of vaccine effectiveness throughout the epidemic wave but tested lower effectiveness values that confirmed the efficiency of regular testing.
The COVID-19 pandemic will probably continue to pose a risk to the safe and normal functioning of schools. Regular testing remains a key strategy to epidemic control in school settings with moderate vaccination coverage or following waned vaccine protection, all the while minimising days lost.
VC and AB conceived and designed the study. EC, GB, and VC accessed and verified all the data and were responsible for the decision to submit for publication. EC, GB, DAC, and CP analysed the data. EC, GB, P-YB, and VC developed the inference framework. EC and DAC developed the code. EC and GB performed the numerical simulations and analysed the results. All authors interpreted the results. VC wrote the Article. All authors contributed to and approved the final version of the Article.
De-identified individual data on contacts of the two schools under study are publicly available at the SocioPatterns project website ( http: //www.sociopatterns.org/datasets/). De-identified aggregated COVID-19 community surveillance data by age class are publicly available at Santé publique France data observatory platform ( https: //geodes.santepubliquefrance.fr/). De-identified aggregated COVID-19 prevalence data from pilot screenings during the alpha wave used in this study are available in the tables reported in the appendix ( pp 24–25).
We declare no competing interests.
We thank Assistance Publique–Hôpitaux de Paris, Santé publique France, Niel Hens, Pieter Libin, Julia Bielicki, Pascal Crepey, and Raphaëlle Métras for useful discussions; Philippe Vanhems, Elisabeth Bothello-Nevers, Olivier Epaulard, Jean Beytout, Annabelle Ravni, Olivier Dugrip, and the Academie of the Auvergne-Rhône-Alpes region for the school screening initiatives; and the Ministry of National Education for supporting the surveillance activities. This study was partly funded by Agence Nationale de la Recherche projects COSCREEN ( ANR-21-CO16-0005) and DATAREDUX ( ANR-19-CE46-0008-03), ANRS–Maladies Infectieuses Émergentes project EMERGEN ( ANRS0151), EU Horizon 2020 grants MOOD ( H2020-874850; paper MOOD 037) and RECOVER ( H2020-101003589), Horizon Europe grant VERDI ( 101045989), and REACTing COVID-19 grant.
Download.pdf ( 4.85 MB) Help with pdf files Supplementary appendix
Modelling results on the impact of COVID-19 testing in schoolsThe COVID-19 pandemic has had widespread health, wellbeing, and economic impacts, both from the disease itself and from the measures put in place to try to control it. By mid-April, 2020, school closures had impacted 94% of the world's students, with the duration and impact of closures varying substantially by country.1 As new variants rise and fall, it is vital to understand ways to minimise both educational and social disruption by keeping schools open while also reducing the spread of infection. Full-Text PDF | tech |
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Rashaad Jorden, Skift
April 1st, 2022 at 12:30 AM EDT
Although the American Hotel & Lodging Association is adamant that companies should resume large-scale business travel, hotels can't rely on it to drive their recovery. Corporate executives don't see the sector making a full rebound anytime soon — if ever.
Rashaad Jorden
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Hyatt Hotels announced they are terminating their association, contracts and relationships with Hyatt Regency Moscow Petrovsky Park in order to comply with sanctions and government directives. Meanwhile over at Skift Forum Europe in London, Accor CEO Sebastien Bazin made headlines by saying Accor does not plan to pull out of Russia. Bazin said they have been in countries of war probably 30 to 40 times over the last 50 years on different continents and never pulled out of any hotel activities at the time employees needed Accor the most. In Russia, Accor doesn’ t even turn a profit with occupancy averaging 35-40 percent, even in good times. Bazin argued that their customers need a safe place to stay, arguing that if they closed up, Bloomberg, CNN or any of the people on the news would not be around and may not even broadcast. He also doesn’ t feel Accor’ s employees in Russia should be punished for government actions.
Skift Note: Hyatt had announced last month it would freeze new developments and suspend investments in Russia.
Fitch Ratings said they expect China’ s tourism sector recovery to remain volatile in 2022 as a result of travel restrictions amid a resurgence of Covid-19 cases. The second half of 2021 showed domestic tourism numbers and revenue decline to around 50% of pre-pandemic levels from over 60% in 1H21 and remained weak going into 2022. Fitch said the government’ s Covid-19 policies are largely driving the sector’ s recovery path and that a rise in virus cases could weigh on tourism activities.
Skift Note: Lockdowns enacted by Beijing following Covid surges in the country have played a major role in Chinese hotel performance falling below the U.S. and Europe in recent months.
The American Hotel & Lodging Association is telling America that face-to-face meetings have undeniable advantages over virtual options, and that businesses and organizations that resume business travel and meetings more quickly are likely to have a competitive edge. The AHLA cited a study from San Diego State University that found 80% of millennials prefer in-person communications with colleagues. Business travel and in-person meetings facilitate productivity, build organizational strength and foster collaboration in a way virtual interactions can not.
Skift Note: Despite the benefits that face-to-face meetings provide, corporate executives largely don’ t see business travel making a full recovery anytime soon — if ever.
UNWTO reported international tourism continued its recovery in January 2022. The Russian invasion of Ukraine, however, adds pressure to existing economic uncertainties, coupled with many Covid-related travel restrictions still in place. All regions enjoyed a significant rebound in January 2022 from the low levels recorded at the start of 2021. Europe +199% and the Americas +97%, continued to post the strongest results, with international arrivals still around half pre-pandemic levels. The Middle East +89% and Africa +51% also saw growth in January 2022 over 2021, but still saw a drop compared to 2019. While Asia and the Pacific recorded a 44% y-o-y increase, several destinations remained closed to non-essential travel resulting in the largest decrease in international arrivals over 2019. By sub regions, the best results were recorded by Western Europe, registering 4x more arrivals in January 2022 than in 2021, but still less than in 2019. Additionally, the Caribbean -38% and Southern and Mediterranean Europe -41% have show the fastest rates of recovery towards 2019 levels. Destinations recording the best results compared to 2019 are: Seychelles, Bulgaria and Curacao, El Salvador, Serbia and Maldives, Dominican Republic, Albania, and Andorra, and Bosnia and Herzegovina. Among major destinations Turkey and Mexico saw declines as compared to 2019. The UNWTO said the war in Ukraine poses new challenges to the global economic environment and risks hampering the return of confidence in global travel. The shutdown of Ukrainian and Russian airspace, as well as the ban on Russian carriers by many European countries is affecting intra-European travel. It is also causing detours in long-haul flights between Europe and East Asia, translating into longer flights and higher costs. According to UNWTO, recent spike in oil prices and rising inflation are making accommodation and transport services more expensive, adding extra pressure on businesses, consumer purchasing power and savings.
Skift Note: The war in Ukraine — as well as travel restrictions not yet lifted — complicate the travel industry’ s path to a further recovery.
IHG Hotels & Resorts and Sunview Companies officially opened the world’ s first Atwell Suites property with the 90-room Atwell Suites Miami Brickell. The dual-branded hotel is in Miami’ s Brickell neighborhood and situated on the top floors of the building shared with the Hotel Indigo Miami Brickell, which opened in March 2021. The first-ever Atwell Suites hotel features a spacious lobby with huddle areas, public co-working spaces, and lounge areas; an inviting bar; and a complimentary beverage station.
Skift Note: The Atwell Suites is one of six brands that IHG has added to its portfolio in recent years, which the company expects to help drive its growth.
International arrivals to the Association of Southeast Asian Nations are projected to increase to 124 million in 2024 from 136.9 million in 2019. Projections for 2022 keep changing, so why should we put any faith in projections for 2024? GlobalData said 2024’ s strength will be boosted by the region’ s natural attractions and heritage, affordable connectivity, improved tourist facilities, rising consumer class, and proximity to India and China. Prior to the pandemic, the ASEAN region was growing at a CAGR of 7.7% between 2016 and 2019 but in 2020, inbound flows to the region dropped -78.8% year over year to 29 million. The member states’ over-dependence on Chinese tourism left them vulnerable. China constituted 23% of 2019 arrivals. | general |
A Look Back: With The Current Market Slowdown, What Did Investors Learn From Other Downturns And What Worries Them Now? | Editors Note: This is the second part in a two-part series looking at the lessons learned from the financial crisis and venture capital’ s pandemic rally. Read Part 1 here.
Barely three months into this year, the current venture market already feels much different than that of 2021.
While last year saw sky-high valuations and VC dollars flood the market at a never-before rate—this year has been full of news about valuation cuts, a slowdown in funding, and a general malaise in the private market that was brought about by a shaky public market, exploding inflation, geopolitical tensions and a continuing pandemic.
However, it was not that long ago when the VC market hit its last major drop. While it’ s true March 2020 brought about the dreaded uncertainty investors hate, the most recent significant dip was in 2008—a global financial crisis brought about by the implosion of the mortgage industry, cautionary lending trends and soaring unemployment.
Many VCs in the market remember those times—and even the more infamous dot-com bust before it in 2001—and while those moments do not provide exact parallels, there are lessons to be learned from previous cycles.
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Hany Nada remembers both the slides of 2001 and 2008, as he was just co-founding the venture firm GGV Capital in 2000 when the dot-com bubble burst. But, Nada—a co-founder and partner at ACME Capital who has invested in such companies as DraftKings, Houzz and Alibaba—sees those downturns as two distinct animals.
The latter in 2008 was brought about by a global financial crisis and was more of a V-shaped downturn—where the high for the time period on Nasdaq hit in October 2007 was eventually reached again less than four years later in April 2011.
The 2001 dot-com bubble burst had much more lingering effects; Nasdaq hit its high in March 2000, but did not get back to that level again until 2014.
For reference, last Nasdaq hit a new high last November, and now the question is how long it will take to get back there again.
“ Is this going to take four or five years? ” he asked. “ Or maybe 24 months to recover? ” Nada said.
If he were to predict, this current market feels much more like 2008-09, and not the dramatic 2001 shift, he said.
“ While fundraising may be difficult right now, customers are still buying the products, ” Nada said. “ This is more of a financial issue than a demand issue. ”
Fundraising started to get difficult in the fourth quarter of last year, with the steepest cuts happening to growth rounds that can be down 30 percent to 50 percent, Nada said. Just last week, delivery startup Instacart slashed its own valuation by nearly 40 percent.
Valuation drops have not affected the early- or seed stages yet, but likely will, he added.
Despite those cuts in valuations, others view the current state of the startup world similar to how Nada sees it.
Don Butler started in the venture world in the late 1990s and has been at Thomvest Ventures for more than 20 years, now serving as managing director. He said he sees some parallels between now and the global financial crisis of 2008, but also some differences.
“ Yes, there are some similarities, ” said Butler, whose investments have included Lending Club, Cylance and Kabbage. “ Part of that is the unknown that we faced then and face now. ”
It’ s true investors hate the unknown and uncertainty, but it’ s equally true they love cash—which also is a compelling difference between now and 2008. When the financial crisis hit, venture and startups were just starting to come off the Webvan and Pets.com highs—and then lows—of the late 1990s and early 2000s. Nearly any startup had raised a warchest like many have done in the last 18 months, where valuations went nuts and investors couldn’ t stop themselves.
“ Companies raised at these high valuations and they raised a lot, ” Butler said. “ Companies have these high cash balances—north of $ 100 million. The average company I see has about two years worth of cash on their balance sheet. People just have so much more money to weather the storm. ”
The storm itself also is very dissimilar, said Robert Siegel—a lecturer in management at Stanford Graduate School of Business and partner at firms including XSeed Capital and Piva Capital.
The issues in 2001 were due to investments in companies that had no viable business model. Years later, the 2008 downturn was not about the tech sector, but rather large global financial institutions—think Lehman’ s collapse—facing mounting uncertainty.
“ It was a time of terror, ” he said. “ People were scared. People stopped spending money ”
That same fear does not exist now, Siegel said. Instead, he sees the industry digesting some of the past excesses and “ gravity coming back ” as the 30x multiples on trailing 12 months ( TTM) revenue are coming back to the more normal 8x to 10x.
Although there may not be panic, investors who remember 2001 and 2008—and even March 2020 for that matter—think there are lessons that can be gleaned from those moments in history, especially for an industry as young as venture.
“ One thing is to make sure your portfolio ( companies) have cash, ” said Michael Skok, founding partner at Underscore VC and an entrepreneur in residence at the Harvard Business School. Skok entered venture just after the dot-com bubble and was an early investor in companies including Acquia and Demandware.
“ Also make sure they are running efficiently, ” he adds. “ For years, it’ s just been about growth, growth. ”
There’ s also the old adage that all investors sing: Great companies are built in difficult times ( or however you want to phrase it).
“ This is when you need to be contrarian, ” Skok said. “ Be greedy when others are fearful. ”
Everyone knows companies like Amazon and Google were built in the runup to the 2001 collapse, while Twitter, Uber, Airbnb, Cloudflare Twilio, Okta and scores of others were founded in the lead-up or during the financial crisis of 2008 as fintech, social media and the digital mobile economy was built.
“ Be bold, ” Skok said.
Another takeaway from 2008 includes forgetting about optics, Nada said. Founders may need to investigate raising the dreaded “ down ” round, or possibly a round with pay-to-play provisions—which basically require existing investors to invest on a pro rata basis in current or future rounds or lose some of their preferential rights. Such provisions are sometimes added to down rounds to make sure previous investors pony up.
The current market shift also could be an accelerant for a societal jump to the next platform, Nada said.
The 2001 change helped bring about a transformation in how people used the web and the devices it’ s accessed on. Less than a decade later, 2008 brought significant changes as social media took hold and mobile computing took off.
Blockchain, advanced sensors and a developing IoT network are all things Nada said he will watch as possible break-out stars during this market disruption.
Others, including Skok, said the COVID pandemic highlighted issues like supply chain disruption that could provide huge opportunities for tech companies—as could the crypto sector and the buildout of Web3 with many infrastructure startups being built up right now in the space.
“ People need the picks and shovels, ” he said. “ You always start at the bottom of the stack. ”
Another thing to watch is the formation of funds, VCs say.
Firms started to downsize funds and even give money back to LPs after the 2001 dot-com bust as venture firms disappeared. Then after 2008, the market saw an explosion of fund managers.
While there are now more firms than ever, the majority of the record-setting venture dollars in the market is concentrated in a handful of large firms.
Just this calendar year alone, Andreessen Horowitz announced a fresh $ 9 billion for its venture, growth and bio funds, San Francisco-based Founders Fund recently closed more than $ 5 billion in two new funds that will be dedicated to both early- and late-stage investing, and just this week it was reported Sequoia Capital China is raising four new funds totaling $ 8 billion.
That’ s just a small smattering of the large funds raised by some of the biggest names in the venture business recently. How these firms, which control so much, react will tell much about the immediate future of the market.
There have already been reports that large crossover firms such as Tiger Global and D1 Capital are pulling back on late-stage investments, with some partners at Tiger reportedly looking closely at more seed rounds.
“ That was certainly one thing we learned in both’ 01 and’ 08, ” Butler said. “ You will learn some syndicate investors will work with founders and others will cut and run. ”
With fewer hands controlling the money, Nada said, how those firms react to the current downturn will have an outsized impact on the private market and bears close watching.
With all of that said, the one thing to also remember is no two downturns are exactly the same—and no one knows what comes next.
“ This seems like more of a cyclical thing right now, because of interest rates, high valuations, inflation, ” Siegel said. “ Now could it be systemic? That depends on what happens next. ”
“ Back in 2008, we were in a financial services meltdown, ” said Jeff Clavier, founder and managing partner at Uncork Capital, which he started in 2004. “ We didn’ t even know if your cash was safe.
“ Everyone went into triage mode, ” he continued. “ It was a race to the best companies. We aren’ t seeing that much now. ”
Clavier—who previously invested in companies including Fitbit, Postmates and Poshmark—said now he sees consumer businesses taking more of the brunt of the pullbacks in the markets, and by the end of April we may have a better idea of what is coming after a lot of enterprise SaaS companies close their books on the first quarter.
“ We didn’ t see a big pullback, pullouts, ” he said. “ We don’ t see it like we did in 2008 … Now could this change with geopolitical issues and other things? Sure. But right now it is still business as usual. … We will see if that changes. ”
No one knows what big event will occur next, or how investors take it, Siegel said—just like the unknown led to wild 30-point daily fluctuations in Yahoo stock back in the first venture dip of’ 01.
“ What comes next? ” he asked. “ No one knows and no one can say they know. ”
What We Learned About Venture Funding During The 2008 Financial Crisis And The Pandemic As The Markets Face Fresh Turmoil
Illustration: Dom Guzman
Stay up to date with recent funding rounds, acquisitions, and more with the Crunchbase Daily. | tech |
Home improvement: Goldman Sachs is betting that you’ ll want a $ 10,000 loan from the investment bank | Goldman Sachs, the 153-year old investment bank, is now officially in the home improvement loan business as it continues a push into the finances of ordinary Americans.
The bank expects to add one million customers a year to its budding Marcus retail division through the acquisition of GreenSky, announced in September at a $ 2.2 billion price tag, Goldman executives said in their first interview after the deal closed Tuesday. GreenSky is an Atlanta-based buy-now, pay-later fintech firm that focuses on construction loans with an average $ 10,000 size.
`` It a great acquisition engine because we expect to bring a million new customers annually through this distribution we're adding to the Marcus ecosystem, '' said Swati Bhatia, a Goldman partner and former Stripe executive. These customers will be able to use the firm's Marcus app, where they will be offered the bank's other products, including savings, personal loans and an expected digital checking account later this year, she said.
The move has broad implications for Goldman investors as it ramps up its ambitions in consumer finance, bringing increased opportunities — and risk. Goldman will start originating GreenSky's loans using its own $ 1.5 trillion balance sheet in the next few months, according to Bhatia, replacing the bank partners GreenSky had leaned on when it was independent.
That will add potentially billions of dollars of new loans onto its balance sheet, which should serve as an engine for generating the type of interest income that powers larger retail rivals like JPMorgan Chase and Wells Fargo.
As a result, Goldman — which typically touts it ability to manage risk as it added products like the Apple Card to its portfolio — will be more exposed to the creditworthiness of ordinary Americans. While GreenSky naturally caters to homeowners, the loans are unsecured, meaning customers ' houses aren't used as collateral if the borrower falls behind.
GreenSky had been originating roughly $ 7 billion in loans a year before it was acquired, although Goldman may choose to securitize some of the loans, depending on market conditions, Bhatia said.
Thanks to a shortage of new construction homes and remote-work trends accelerated by the coronavirus pandemic, demand for home improvement loans has been robust, according to GreenSky founder David Zalik, who is joining Goldman at the partner level.
`` It's amazing how resilient that business is, even with a pandemic, with supply chain challenges, rising interest rates; the demand has been tremendous, '' Zalik said. `` There was two months in the pandemic where we didn't grow, and then it went through the roof. People want to invest in their homes. ''
Customers typically come to GreenSky through the fintech's network of 10,000 merchants, which range from small businesses to some of the biggest U.S. home improvement brands. Users choose the length of repayment periods that may vary from 36 to 84 months and can repay loans early `` at any time, '' according to Zalik.
`` The consumer appreciates that if the total project is $ 15,000, I can buy it for $ 90 a month at a low single-digit interest rate, '' Zalik said. `` It helps the consumer afford and manage their cash and helps the business sell their product, no different than Toyota sells a lot more cars because financing is available. ''
The integration of GreenSky systems into Goldman will take through the rest of the year and possibly into 2023, Bhatia said. With that, the bank will be closer to its vision as a provider of multiple digital products, both directly to consumers as well as via partners.
`` Eventually as we complete the integration, we will be able to offer products across the spectrum to all of our customers, '' Bhatia said. `` We are working on creating one seamless digital experience for our customers. '' | business |
Ukraine war: Could European countries implement oil and gas rationing? | European countries are facing the possibility of energy supplies being rationed, as a dispute between Moscow and the West over payments for Russian exports rages on.
European countries are heavily dependent on Russian oil and gas deliveries, but Moscow's invasion of Ukraine in late February saw the EU and the U.K. impose a barrage of sanctions that included cutting down on Russian energy imports.
In early March, the EU pledged to cut Russian gas imports by two-thirds before the end of the year, while Britain has said it will phase out Russian oil imports by the end of 2022.
But those moves come with risks for a region already facing an energy crisis. Tight natural gas supplies saw wholesale prices surge to record highs in Europe last year, with households in Britain due to see their energy bills rise by more than 50% from April 1.
Germany warned on Wednesday that it may soon be facing a natural gas emergency that could necessitate the rationing of gas supplies. German Economy Minister Robert Habeck said the `` early warning '' measure did not yet mean the country had to resort to rationing gas but called on consumers and companies to reduce their energy consumption.
Meanwhile, Austria's government announced Wednesday that it had activated the first step of a three-stage emergency plan that would see it monitor the country's gas market more closely. Officials cited Russia's demand for payments in rubles as the reason for the triggering of the contingency plan, noting that if it reached the third stage in the plan, emergency control measures such as rationing may come into force.
According to Chi Kong Chyong, director of Cambridge University's Energy Policy Forum, Germany and Austria may not be alone in having to implement extreme emergency measures if Western countries continue to lock horns with Russia.
Putin said last week that the Kremlin will seek payment in rubles for gas sales from `` unfriendly '' countries — a demand that has been rejected by the G-7 nations. On Thursday, the Russian leader said he had signed a decree saying foreign buyers must pay in rubles for Russian gas from April 1.
`` If they can't agree on payment terms and gas flow from Russia is stopped, then other European countries will also have to take emergency measures, '' Chyong told CNBC. `` Despite entering a warmer period when we consume less gas, we still need gas to flow into our storage facilities to use it in the upcoming winter months when temperatures drop and we need gas for heating again. ''
`` If Russian gas flow stops, all European governments — including the U.K.'s — need to start activating emergency plans including 'front loading ' public campaigns to ready our citizens to save energy in the winter months, '' he added.
Meanwhile, Jim Watson, a professor of energy policy and the director of the UCL Institute for Sustainable Resources, said it was `` certainly possible '' that the U.K. could see a government-imposed rationing of fuel for cars.
Britain faces more difficulty shifting away from Russian oil than it does with moving away from Russian natural gas because it was more reliant on oil imports, Watson told CNBC via telephone.
Speaking to British lawmakers in a meeting of the U.K. Parliament's Treasury Committee in March, Amrita Sen, director of research at Energy Aspects, warned that sanctions on Russian energy exports could have serious ramifications for Europe.
`` Russia has a lot of other intermediaries and other companies that would buy and sell its crude products, '' she said. `` Particularly in terms of products, diesel is where we fear rationing could come as soon as the end of this month in Germany. You could absolutely see the repercussions of that in the UK as well. ''
Meanwhile, Russell Hardy, CEO of Swiss oil trader Vitol, told an FT commodities summit last month: `` Europe imports about half of its diesel from Russia and about half of its diesel from the Middle East. That systemic shortfall of diesel is there. ''
`` Rationing of diesel is a possibility, '' he added, according to The Times.
The U.S. Energy Information Administration estimates that Russia exported 4.7 million barrels of crude oil a day in 2021 — almost half of which went to European OECD countries. The Netherlands, Germany and Poland imported the most Russian oil in the region.
Meanwhile, 74% of Russia's natural gas exports went to OECD Europe last year, according to the EIA.
Implementing policies that reduce public demand for oil could help the U.K. government to decrease its reliance on imported oil, Watson suggested, arguing that a push toward public transport uptake and the introduction of other behavioral policies `` that are about people and their choices '' are also `` certainly possible. ''
Last year, panic-buying of gasoline in Britain led to severe shortages that saw many gas stations running dry, with army personnel being deployed to deliver fuel. But Watson noted the current situation was different, and a more likely outcome of the risks around energy supply was a continuation of high prices in the U.K. — a country currently facing its worst cost of living crisis for decades.
`` I think there is a bit of a challenge to setting those [ measures ] out as top-down policies with the government saying the population should drive slower, drive less, fly less, move to public transport, '' he said.
Earlier this month, the International Energy Agency published a report that laid out 10 policies it said could help quickly cut global oil demand by 2.7 million barrels a day. The policies, intended for implementation in `` advanced economies and beyond, '' included reducing speed limits on highways by 10 kilometers ( 6.2 miles) an hour, making public transport cheaper, introducing car-free Sundays and alternating the use of private cars in large cities.
Rory Stewart, former British International Development Minister and a senior fellow at Yale's Jackson Institute, said in a tweet earlier this month that it is possible to cut the income Russia receives from oil exports by focusing on reducing demand.
`` It would take a government and civilian effort equivalent to the Covid response, '' he said.
His proposed policies, which he said should remain in place throughout the crisis in Ukraine, included reducing the U.K.'s speed limits to 50 miles per hour, making all public transport free, and calling on companies like Uber to open technology that would allow free civilian ridesharing.
`` This would reduce demand and price of Russian oil, [ and ] have a catastrophic impact on Putin, '' Stewart said.
Cambridge University's Chyong told CNBC that the key to hurting Russia through energy sanctions was implementing policies that focused on slashing demand.
`` This point is about trying to bring down demand for fossil fuels — this is our true and effective weapon against Vladimir Putin, '' he said.
`` An exponential negative relationship between demand and prices [ exists ] because right now we are facing a globally very, very tight energy system and every extra unit of demand will cause prices to rise disproportionately high. The flip side of this effect is that reducing our demand will have disproportionately high marginal benefit – drastically reducing prices. '' | business |
FBI: Ransomware attacks are piling up the pressure on public services | Cyber criminals are targeting healthcare, emergency services and local government because they know people's everyday lives rely on these critical services.
Danny Palmer is a senior reporter at ZDNet. Based in London, he writes about issues including cybersecurity, hacking and malware threats.
Ransomware attacks are creating risks to safety by disrupting public services including utilities, emergency services and education, the Federal Bureau of Investigation ( FBI) has warned.
The alert says that local government agencies are attractive targets for cyber criminals to hit with ransomware, because they oversee critical services on which the public depends.
Ransomware attacks against local governments have caused disruptions to healthcare, emergency services and safety operations, and have seen sensitive personal data stolen by hackers, putting individuals at further risk of fraud and cybercrime. The attacks targeting local services show no signs of slowing down.
`` In the next year, local US government agencies almost certainly will continue to experience ransomware attacks, particularly as malware deployment and targeting tactics evolve, further endangering public health and safety, and resulting in significant financial liabilities, '' warned the alert, which details how several ransomware attacks over the past year have caused disruption to vital everyday services.
For example, the FBI details how a January 2022 ransomware attack forced a US county to take computer systems offline, close public offices and obliged it to run emergency response operations on backup contingencies.
The attack also knocked out county jail surveillance cameras, data collection capabilities, internet access, and deactivated automated doors, resulting in safety concerns and a facility lockdown.
Another ransomware incident against local government services in September 2021 led to a county courthouse being closed and cyber criminals stealing personal information about residents and employees. The hackers published the data on the dark web after the county refused to pay the ransom.
In May 2021, a PayOrGrief ransomware attack infected local US county government systems, making servers inaccessible and disrupting online services, including the ability to book COVID-19 vaccination appointments. The attackers claimed to have stolen 2.5GB of data containing internal documents and personal information.
The examples of cyberattacks detailed in the alert represent just a small fraction of the total number of ransomware incidents against government services during the past year alone – and only higher education and academia were more common victims for ransomware attacks during 2021.
While the FBI and other law enforcement agencies say victims of ransomware attacks shouldn't pay the ransom demand for a decryption key because it just encourages further attacks, in many cases the victims will pay because they feel as if it's the quickest way to restore vital services – it's why criminals target public services.
But even if victims pay the ransom, restoring the network is an arduous task – and there's no guarantee that the decryption key will work properly, or that the ransomware gangs won't return with more attacks.
Whether the victim pays the ransom or not, the FBI urges US organisations to report ransomware incidents as it could help prevent future attacks against others.
The FBI has listed several cybersecurity measures that organisations can implement to help avoid becoming the victim of a ransomware attack. These include keeping operating systems and software up to date with security patches, so cyber criminals can't exploit known vulnerabilities to access networks, and to require strong, unique passwords for online accounts, so it's trickier for hackers to guess passwords.
It's also recommended that organisations require multi-factor authentication for online services including webmail, VPNs and accounts with access to critical systems, in order to provide an additional barrier against attacks.
Organisations should also keep offline backups of data and ensure they're regularly updated and tested, so in the event of a ransomware attack, it's possible to restore the network without paying cyber criminals for a decryption key.
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AmCham survey on China's latest Covid lockdowns, American businesses | BEIJING — China's worst Covid wave since the initial shock of the pandemic has cut into annual revenue projections for roughly half of American businesses in the country, a survey showed Friday.
The Beijing-based American Chamber of Commerce in China and its Shanghai counterpart surveyed 167 members operating in China, including 76 manufacturers, this past Tuesday and Wednesday.
The metropolis of Shanghai, where many foreign businesses are located, entered a two-part lockdown this week as municipal authorities sought to control a brewing number of Covid cases. Those measures followed shorter lockdowns in the tech hub of Shenzhen, the manufacturing hub of Dongguan and travel restrictions across the country.
The survey found that 54% of respondents have lowered 2022 revenue projections for the year due to the latest Covid-19 outbreak.
Among manufacturers, more than 80% reported slowed or reduced production, as well as supply chain disruptions.
Nearly all, or 99%, of respondents said the latest outbreak had affected them.
Since the pandemic began in 2020 and China tightened restrictions on international travel, foreign businesses in China have complained of long quarantine requirements upon arrival and difficulties of bringing in senior management or technical staff.
If China's current Covid-19 restrictions remain in place for the next year, half of respondents to this week's AmCham survey said they would reduce investment. Nearly 75% of respondents said maintaining those restrictions would reduce their revenue and profit.
And nearly 20% of manufacturers said they would move manufacturing or operations out of mainland China if the Covid-19 restrictions remained.
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While just about half of respondents overall were satisfied with China's efforts to control Covid's spread, the top three aspects of dissatisfaction were the length of required quarantines, restrictions on travel to China and the lack of flights to China.
The top three recommendations from survey respondents were to allow for home quarantine or other options, simplify requirements for coming to China and allow more flights into the country.
The number of new Covid cases and deaths reported in mainland China remains well below that of major countries. | business |
The Robin Hood of Odessa | The foyer of the Pensioners’ Society building in downtown Odessa is quiet. A painted Russian Orthodox saint looks sternly down from the wall at the gaggle of old ladies gathered beneath. Then a little dog starts yapping as Timur Matsaberidze, a 27-year-old ship’ s cook, strides through the door. The old ladies grin.
Odessa is one of the few big cities to have escaped bombardment since Russia invaded Ukraine weeks ago, but supplies are running low and most of its shops are closed. Local government officials are too busy organising the city’ s defence to ensure that food gets to the elderly, so that task has fallen to volunteers like Matsaberidze. There are 80 old people affiliated with the pensioners’ club, he explains, as he and his crew unload macaroni, rice and potatoes from a battered, white Mercedes van parked outside: “ The government can’ t help them, so I do. ”
Matsaberidze looks like he’ d be more at home in a seedy port bar than among a group of grannies. He’ s bony and heavily tattooed with a shaven head and clownish smile. But the old ladies can’ t get enough of him. They’ re murmuring thanks and blessings, and the white-haired director of the pensioners’ club is reaching for Matsaberidze’ s hand when his phone starts buzzing and he has to head back to the van. There’ s no time to chat.
Odessa has been on edge for weeks. Beaches that once welcomed Russian tourists are being mined, and the city centre is full of tank traps and barricades. Everyone knows Odessa could be cut off from the world at any time: there are Russian troops to the east and west, and a fleet of Russian naval vessels close by in Crimea. Air-raid sirens go off regularly, sending people scampering into bomb shelters.
The nervous energy has infected Matsaberidze. He’ s hardly had time for a cup of tea since Russia invaded, he says; the only thing I see him consume in our two days together is a single half-cooked potato. From first thing in the morning until the curfew starts at 8pm he’ s on the road, delivering food and clothes to soldiers, retirees, disabled people and anyone else in need, trailed by a small posse of sailors and musicians.
After unloading all the food the crew heads back to the van, the side of which is plastered with the words “ Russian Ship, Go Fuck Yourself ”. ( The phrase, reportedly uttered by a Ukrainian border guard who was asked to surrender, has become a rallying cry across Ukraine.) As he moves to open the door, Matsaberidze giggles, nudging a dog poo with his shoe and citing a Ukrainian proverb that says stepping in it will bring good luck. Odessa needs it.
At the wheel of the van sits Yaroslav Prokhorov, an old friend of Matsaberidze. Long-haired and good-looking, Prokhorov was a semi-successful drummer until the war forced all nightclubs to close. In the back is Matsaberidze’ s cousin Nikolai, a heavy-set boatswain on a merchant shipping line. The half-dozen others who come and go throughout the day are a likeable, bohemian lot, with little money and a typically Odessan mix of backgrounds; one tells me that she is part-Jewish, part-Muslim and part-Roma.
The van is filthy, with old cardboard and plastic bags on the floor; most of the seats have been ripped out to make room for deliveries. This space is filled with a random assortment of goods ranging from medicine and nappies to vodka for the soldiers. Matsaberidze says some of those guarding the city’ s entrances are literally shivering from hunger ( he immediately regrets telling me this because he fears it will harm morale if it got out). One of their friends was called up for active duty and was given no armour or boots, Prokhorov adds, so they crowdfunded to buy him some.
As we lurch round a corner, Matsaberidze fills me in on his day so far. “ I got up this morning, no breakfast, no time for it, ” he says, speaking rapidly in what he calls “ Seaman’ s English ” ( vaguely accented and short on prepositions). “ Five thousand people hungry in Odessa. ”
Matsaberidze calls their method for sourcing supplies “ the Odessa system ”: a mix of charm, chutzpah and connections, sometimes brushing the edge of legality. He wheedles restaurant owners or wholesalers for leftover food, persuades people fleeing Ukraine to donate anything they don’ t need and picks up whatever he can on the city’ s lively black market.
Social media helps too. Recently a single mother texted him in urgent need of nappies and baby food. Realising that he didn’ t have anything suitable, he posted a call-out on Facebook and Instagram. He managed to find someone who had the right size of nappies, drove to his apartment and then delivered the goods to the mother. He’ s juggling several such supply chains in any given day. “ It shows how our city works – a very big communication, very open to all people, very spontaneous, ” he says. He tries to help with most requests, though he does mention one woman who asked him to break into a neighbour’ s apartment and loot it for her. “ I said to her ‘ no, I’ m not a criminal’. ”
The soldiers manning the city’ s checkpoints are jumpy, fearing Russian saboteurs. Recently, a member of Matsaberidze’ s team was making a delivery just after curfew when a group of soldiers fired their guns in the air and forced him to his knees. Some unlucky Odessans have been shot in similar circumstances. “ It’ s so chaotic now, ” Matsaberidze says. “ If a Russian guy came to my house, I could kill him, throw his body out and nobody would say anything. ”
“ I closed the door, watched the news, saw the attacks. I started crying, asking, what can I do? ”
It’ s not just the city’ s human population that benefits from the battered Mercedes. After we turn out of Spartakovskaya street, Matsaberidze tells me we’ re on our way to feed some raccoons at a petting zoo. Animals need to eat too. A woman in a green blouse instructs us to empty our pockets before entering the animals’ room: the naughty raccoons will steal everything. A minute later, dozens of furry, lumbering creatures envelop us. Matsaberidze picks one up and it nuzzles him like a dog. The animals seem to make everyone happy. “ In this hard time, when you come to this place, it’ s very good for you, ” says Matsaberidze. He disentangles himself with reluctance.
The streets of Odessa are mostly deserted these days, but advertising hoardings bear new patriotic slogans. “ If you mess with Mama, Mama will bury you ”, says one, a playful reference to the city’ s long-standing nickname, “ Mama Odessa ”. Joking is intrinsic to Odessa’ s identity. The city is known for its comedy clubs and has an annual festival of humour on April Fools’ Day ( this year it’ s been cancelled).
Many of the Soviet Union’ s most famous comedians were from Odessa, including Leonid Utyosov, a personal favourite of Stalin, and Mikhail Zvhanetsky, who was once described as the “ Seinfeld of everyday Soviet misery ”. Matsaberidze says he even met Ukraine’ s president, Volodymyr Zelensky, at a comedy gig in the city when the country’ s wartime hero was just doing stand-up ( “ nice guy ”).
It’ s hard to say exactly what Odessa’ s sense of humour consists of: “ It is like bitcoin ”, ventures Matsaberidze, trying to work out how to capture its mixture of sadness and irreverence. “ It doesn’ t exist, but it exists. ” Others agree it carries an expectation of misfortune that speaks to the city’ s history. After Catherine the Great founded Odessa as a free port in the late 18th century, it became a polyglot hub for Bulgarians, Greeks, Poles, Russians and other groups. Much of the city’ s distinctive neoclassical architecture was built during its prosperous 19th century. Since then it has been in a state of protracted, crime-ridden decline; its Jewish population reduced from a third of the city’ s inhabitants to just a small fraction by successive pogroms, followed by the Holocaust.
Unsurprisingly, the city’ s humour has always tended towards the pitch-black. “ Barber, why must you always talk politics? ” runs one of the best gags from the Stalin era. The answer? “ Because your hair is so much easier to cut when it stands on end. ”
Some of the best jokes I heard in Odessa came from Rabbi Avraham Wolff, a ruddy-faced 50 year-old with a greying beard, who has been trying to help the city’ s remaining Jews escape. “ Every time you throw a rock you hit a Jew or a cat, ” the rabbi says cheerfully. “ The last time this happened, Moses brought the Jewish people out of Israel. They also had no passports. ”
Not all Odessan wit translates. At the end of one day’ s scavenging, Matsaberidze says to me apropos of nothing: “ We trust in the armed forces of Ukraine, God and the AK-47! ” I’ m not sure whether I am supposed to laugh, repeat it back to him or look solemn. He shrugs: “ It sounds better in Ukrainian. ”
A vast, frenetic citizens’ movement is coalescing in Odessa. Groups of women gather to make camouflage netting. Men weld old train rails into tank barriers. Other volunteers have been lugging mattresses and blankets down into the city’ s vast 19th-century network of subterranean catacombs.
It’ s hard to say how long this newfound unity will endure. Before the war, Odessa was divided between those who felt aligned with Moscow ( the city has a particularly high concentration of ethnic Russians) and those who saw themselves as primarily Ukrainian. The two factions clashed violently after the Euromaidan protests in Kyiv in 2014. Moscow’ s subsequent invasion of eastern Ukraine turned many in Odessa against Russia, especially young people like Matsaberidze, but the webs of money and influence linking the city to its former rulers remained strong.
On the city’ s southern beachfront, I meet a few dozen people making sandbags to use for fortifications. One of them, a tall, striking figure with long hair and huge eyes, is singing the national anthem, “ Ukraine Has Not Yet Perished ”. He turns out to be Andriy Kharlamov, a 33-year-old bass baritone with the Odessa National Academic Opera and Ballet Theatre. When the song is over, he tells me that at least 20 other classical musicians he knows are now part of the civil defence. He laughs about it, but when I ask about their prospects for returning to music his face turns sober. “ We must be realistic, ” he says. “ They said coronavirus would be over in two weeks. I think this war will last years, like Afghanistan. The Russians don’ t want this to end. ” The translator I am working with, a young woman who has chosen to stay in Odessa with her husband and two children, bursts into tears.
After dropping off some spare goods in the makeshift depot in Prokhorov’ s garage, Matsaberidze invites me back to his own flat in a working-class neighbourhood. The tiny apartment is at the end of a dim, sour-smelling cement corridor. It has almost no furniture and one window is made of plastic sheeting and tape. Matsaberidze was able to buy it after spending an entire year on a container ship during the pandemic, saving most of his monthly salary of $ 1,400. One of his cousins has been napping on the single sofa. A pot of congealed lentils sits on the table.
I point to Matsaberidze’ s abundant tattoos, and he obligingly explains a few of them: a ship, a pot-smoking tiger with reddish eyes, an ancient sun symbol. And, of course, a mermaid ( “ it’ s logical ”). In between seemingly endless phone calls, Matsaberidze tells me how he came to be the Robin Hood of Odessa.
When the war broke out the first thing he did was help his ex-wife and their eight-year-old daughter escape to Moldova, leaving him with only $ 250 to his name. His girlfriend wanted to leave too, and he gave her $ 150 for the journey – she hadn’ t decided where to go. Left alone with his two-month old kitten, Mireslava, he sat on the sofa: “ I closed the door, watched the news, saw the attacks. I really started crying, asking, what can I do? I can not just watch. ”
As he was wondering what to do, the phone rang. It was Prokhorov, also in tears. Matsaberidze hadn’ t spoken to him in more than a decade because of a row over a girl, but the war seemed to make that feud irrelevant. The old friends traded rumours: both had heard that the city’ s defenders were cold and hungry. They decided to meet up the next day to gather food and clothes for them – Prokhorov had the family van because his parents had already fled. After that, “ it was like magic, snowball, ” Matsaberidze says.
The municipal authorities have noticed Matsaberidze’ s resourcefulness. As I was preparing to leave Odessa he told me he had been allocated a bomb shelter to use as an office and storage space. He gave me a brief tour: the ratty-looking basement smelled faintly of bilge water. “ It’ s not a Sheraton five-star, but there are three exits, that’ s really good, ” he says. An old man appears to have moved into one of the rooms, and Matsaberidze chats amiably with him. Anyone is welcome.
I shiver in the cold. Matsaberidze sees, and gleefully uses the opportunity to advance one of his theories about the city. Apparently the temperature dropped just as the Russians invaded. Do I know why? “ It’ s because of witches making spells. We have lots of witches, ” he says, grinning with pride at Odessa’ s unstoppable eccentricity. “ Almost everyone, actually. ” ■
Robert F. Worth is the author of “ A Rage for Order: the Middle East in Turmoil, from Tahrir Square to ISIS ”. You can read the rest of 1843 magazine’ s coverage of the war, here
Ilya Smetanin had a passion for Soviet-era planes. Now he faces trial for treason
Russia’ s president thought Ukraine would fold when invaded. History shows its people come together in adversity
Published since September 1843 to take part in “ a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress. ”
Copyright © The Economist Newspaper Limited 2022. All rights reserved. | business |
Stelvio bans rim brakes, Ribble unicycle, E-Chamois cream, road tax, Cancellara's comeback, oval cassettes — cycling does April Fool's Day; MGIF WTF; I 'm dreaming of a white Tour of Flanders; Buy 8 chains get 1 free; ( Ned) Flanders + more on the live blog | Like this site? Help us to make it better.
Who knew this would turn into a trilogy? It's time for part three of cycling's April Fool's antics... This is our Return of the Chainring, The Pogfather 3, The Girl Who Kicked The Hornet's FTP Test, X-Men: The Last ( Track) Stand, The Matrix ( 90) Revolutions ( Per Minute). The story ends here ( for another year)...
But, unlike The Godfather, we might just have saved the best for last...
First to the stage: Muc-Off's invisible jersey...
It's those pesky cyclists not wearing hi-vis again...
Next up, a classic from Velotech who have reinvented the cassette. Remember when Chris Froome started running osymetric chainrings and the cycling world melted? ( Even if Bobby Julich was, as far as we know, the first to do so back in 2004) Well, here's the follow-up...
Veloskin got the memo too... announcing an E-Chamois cream.
`` With e-bike sales spiking, we have jumped on the trend to provide a specific Chamois Cream to keep your e-riding supercharged! Formulated to keep both rider and bike in harmony and synchronised, the new Veloskin E-Chamois Cream contains groundbreaking nano technology blended with our traditional ingredients, which can extend and improve the performance of your e-bike's battery! ''
Bike subscription service Swapfiets was pleased to announce the `` world's-first penny-farthing subscription service ''... available for just £10 per month, a lock for added security, and the guarantee of a free replacement if yours is stolen...
And finally, before my brain shuts down, Canadian Cycling Magazine went for the'story ' about the UCI announcing that all cyclists must install a dropper post, following Matej Mohorič’ s historic win at Milan-San Remo.
> road.cc Podcast: Matej Mohorič says he could have descended faster at Milan-San Remo if motorbikes weren’ t in the way
It really is amazing how much big news drops on the morning of April 1...
> 2022 Specialized Allez Sprint vs Tarmac SL7: which is best?
As you 'll see from the title here, I forgot to leave the horrendously bad puns on holiday...
Anyway, Dan Lloyd flexed his sunrise views for the Twitter world to enjoy this morning.
The response he was ( probably) not looking for was Matt Stephens ' very nearly NSFW holiday snap from a Belgian getaway. As far as rom-com premises go: two retired bike racers finding each other during a cobble-packed classics weekend in Belgium might be a bit niche...
Remember this Belgian sunrise? pic.twitter.com/gi16u6KJzW
— Matt Stephens ( @ RealStephens) April 1, 2022
Dan got the last laugh ( along with the rest of us)...
I don't. I remember it was a tiring trip though. pic.twitter.com/Y83L9l12x6
— Daniel Lloyd ( @ daniellloyd1) April 1, 2022
What goes on Tour of Flanders stays on Tour of Flanders...
The Ineos boys sheltered from the snow in Belgium this morning, choosing to take their training ride indoors...
We woke up to snow this morning in Belgium ❄️
No worries, we fired up @ GoZwift and the guys jumped on their @ tacx trainers. Those Virtual Training Camp sessions coming in handy 🙌 pic.twitter.com/tKeTiR9Cll
— INEOS Grenadiers ( @ INEOSGrenadiers) April 1, 2022
Tadej Pogačar did not...
The two-time Tour champ, and soon-to-be Ronde debutant, took to the snowy Belgian countryside to reccy some of the route, including the Oude Kwaremont. Hard as nails but just imagine the fuss if Pog had slipped and broken a bone though...
Yorkshireman Connor Swift was out enjoying the warm weather too... just like back at home, eh? 'This would be a mild spring afternoon back in Dales '...
There was simply too many April Fool's ruses to pack into part one... so we're back with a sequel...
First up, the CAMO-HANGAR [ ©️ ], possibly the joke most worthy of being followed up on...
Don't want to disrupt our car dominated landscape with cycle storage?
Try the all-new CAMO-HANGAR©️ from Possible!
✅Blends in with all other SUVs ✅Won't trigger anti-cycling sentiment ✅Only pay for parking 1 car a year instead of 5 bikes pic.twitter.com/TYQKHdQ3vT
— Possible ( @ wearepossible) April 1, 2022
Or how about the Pearson Tearaways, a cleat alternative that we're not sure will stick ( ba dum tss). As per the shiny press release which would put many genuine product launches to shame... '' As the world’ s oldest cycling company, Pearson has been championing innovation since 1860. In an exciting new collaboration with cycling shoe specialists Lake, Pearson is proud to announce the Pearson + Lake Tearaway Cycling Shoe. Designed for life on and off and on the bike, they’ re the perfect choice for anyone tired of click-clacking around in cleats. ''
The product?
`` Grafted to a luxury Lake sneaker-trainer, the Tearaways feature proprietary RUG® technology. The acronym stands for ‘ Road, Urban, Gravel’ because this really is the only cycling shoe you’ ll ever need. The secret lies in the sole ( a bit like life), which features a Vibram base for exceptional stiffness and durability.
`` This has been overlaid with our ground-breaking slip-free Velcro, to offer class-leading pedal adherence. The shoe is supplied with corresponding, complimentary pedals, and which, again, boast technology developed exclusively by Pearson. ( And Lake, obviously.) '' This might be the best one yet...
Sliding away from cycling for a second, Little Tikes are taking on soaring fuel prices...
And finally, CloseTheGap got the'scoop ' on cycling governing bodies making bells mandatory in all road and mountain bike races from 2023, although with midday coming and going, and the ruse rubbished, we 'll leave it to you to decide who's the only bell in the peloton...
What a morning...
Finally we can all stop duping each other into believing silly things. Unfortunately that means admitting ( although I 'm sure you already realised) the road.cc L-shaped Crank Commemorative Plate to mark the retirement of our famous feature was an April Fool's too...
So... does that mean the classic feature will be making a return to your screens at some point? Don't ask me, and please kindly direct your abusive comments elsewhere if/when it inevitably does...
Now it's time for our obligatory round-up from the rest of the cycling industry, and boy is there a lot to get through. Let's hope all of these are actually April Fool's ruses...
First up, the latest model to Ribble's endurance range: the Endurance Mono SL, the brand's first-ever unicycle, apparently to be ridden by Ribble Weldtite Pro Cycling rider Cameron Jeffers at this summer's Unicycle World Championship. `` One wheel, double the fun! '' A strong start.
A post shared by Ribble Cycles ( @ ribble cycles)
Next up, a personal favourite — Band of Climbers waded into the angry comment-infested waters of the rim brake vs disc brake rivalry, stoking the flames with an ingenious Fool's post... rim brakes are banned from descending the Stelvio... Chris Froome won't be happy...
`` Some surprising news to bring you this morning from Italy, and the Passo dello Stelvio. Band of Climbers has learned that bikes with rim brakes are to be completely banned from riding on the Stelvio. The new rule, which comes in place as of today, means only those riders with disc brake bikes are allowed to climb, and crucially descend Italy's most famous mountain road.
`` We 've been told about 'Rim Guards ' who will be stationed on the foot of each side of the climb, who will stop any Rider with Rim Brakes. We 've also been told that It's possible to hire a disc brake bike from the 'Rim Guards ' for €15 per hour. '' Superb.
A post shared by Band of Climbers ( @ bandofclimbers)
Evo Cycles, a bike shop from New Zealand, got involved too, claiming: `` The NZ Transport Agency ( NZTA), have reached out to Evo as a key figure in the cycling industry and asked us to help with gathering information for their research.
`` NZTA are seeking feedback on a proposed 'Bicycle Registration and, Road User Charges ' ( BUC’ s). Essentially all cyclists would need to register their bikes and pay road charges — similar to vehicle owners paying charges and fuel taxes for the upkeep of roads. The introduction of BUC’ s would use that same principle to take care of NZ’ s cycleways.
`` Mountain bike trails are also set to benefit from the charges, with Waka Kotahi planning to allocate some of the funding to their upkeep. The new bike registrations and BUC’ s are proposed to come into effect in early 2023. Registration is proposed to cost $ 80 per year and BUC’ s are proposed at $ 10 per 100km. ''
Those on the Ribble Endurance Mono SL will only have to pay half, as per the unicycle bracket, while kids have to pay double because... '' they're all troublemakers ''.
Elsewhere, we had:
Wiggle getting rid of Haribo...
We regret that we have decided to withdraw the Haribo from Wiggle orders. Occasionally it is missed from orders in error which causes understandable disappointment so we 've decided to discontinue this freebie altogether. pic.twitter.com/cANADYELXf
— Wiggle ( @ Wiggle Sport) April 1, 2022
Spartacus ' return...
Three-time Paris-Roubaix winner Fabian Cancellera is planning a comeback, with this year’ s Rutland Melton International CiCLE Classic ( 24 Apr) set to be his first race
1/2 pic.twitter.com/Fx6ngm6PPk
— The British Continental ( @ BritishConti) April 1, 2022
And the Scottish Headwind Championships which, considering the Dutch version, is actually almost believable...
We are proud to announce a brand new # SCNatChamps for 2022, the Scottish National Headwind Championships.
This brand new event will see riders ride into a furious block headwind in a time trial-style event, with the rider with the fastest time becoming the Nat. Champ. pic.twitter.com/CeAZOO7fdJ
— Scottish Cycling ( @ ScottishCycling) April 1, 2022
I 've barely even scratched the surface of April Fool's Day there, we 'll be back with part two in a bit...
Hi-Diddly-Ho, cycling fans! It's time for another 10/10 team announcement...
Here's who Ned will be cheering for on Sunday🦁 # RVV22 pic.twitter.com/TTe4r1lAyb
— Trek-Segafredo ( @ TrekSegafredo) April 1, 2022
A bit of a milestone for me - made a full chain out of all the spare links from all the chains I’ ve got through since I built the Flare. 8th chain just gone on after 6,559 miles, so just over 900 miles per chain - year-round riding & out in all conditions # mtb # mtblife # cycling pic.twitter.com/9BqXgro2fm
— Stephen Morrison ( @ mozzasnaps) March 30, 2022
Stephen Morrison...
Koppenberg # RVV pic.twitter.com/9AjwxOTcgD
— Aitor Agirrezabal ( @ aagirrezabal) April 1, 2022
The slippy stones of the Koppenberg are hard enough in the rain. In the snow and ice? Forget about it...
The snow continues to fall in Flanders, but is not sticking to the roads, so all should be well for Sunday's races ( especially considering the weather forecast we shared on the blog earlier).
We wondered if teams would cancel their recon rides, and Bora-Hansgrohe appear to be the first to break rank...
Bora-Hansgrohe has postponed its Flanders recon because of the snow in Flanders. It's still coming down, though it's not sticking to the roads. Won't be around on Sunday, we hope.
— Sadhbh O'Shea ( @ SadhbhOS) April 1, 2022
Unless that's their entry for the most underwhelming April Fool's award...
Call for e-bike and e-scooter battery safety campaign after London Fire Brigade reports spike in call outs # ebikes # escootershttps: //t.co/4wzMmHgqML pic.twitter.com/9PdMVqayKh
— ebiketips ( @ ebiketips) April 1, 2022
> Call for e-bike and e-scooter battery safety campaign after London Fire Brigade reports spike in call outs
In February it was announced that E-bikes had been banned from the Houses of Parliament due to fire risk. Labour peer Lord Berkeley revealed he had been told he could no longer arrive by e-bike, and said it was because `` they might set the building on fire ''.
However, Lord Berkeley added that he believed the advice, possibly from the Department for Transport after Transport for London banned the bikes on all public transport, was `` misinterpreted ''.
The teams in Belgium have woken up to snow on the ground in Flanders...
April doet wat hij wil. @ RondeVlaanderen pic.twitter.com/1TvGxdySVy
— Ard Bierens ( @ ard bierens) April 1, 2022
There's plenty of times ( a day) I 'm jealous of the pros. Waking up for a recon on cobbles in those conditions is not one of them. Perhaps a forgiving, and slightly nervous sports director, will postpone training until the afternoon?
Two days to # RVV22 🌨 pic.twitter.com/5KH9XvD1fb
— Trek-Segafredo ( @ TrekSegafredo) April 1, 2022
Will the snow stick around for the races on Sunday? It doesn't look likely. The forecast is predicting light snow until lunch time, and despite lows of -3 overnight, the cobbles should stay dry until Sunday.
One team who won't be on the startline is Israel – Premier Tech, who have withdrawn due to medical reasons. The squad's Flanders line-up suffered a second covid positive yesterday, having already been depleted by illness and injury, and with other riders in Spain for GP Miguel Indurain, the team of Sep Vanmarcke has decided to skip De Ronde.
Manager Kjell Carlström explained the decision is in the best interests of the team and peloton: `` This decision has not been taken lightly but we feel this is our only option at this stage. It is no secret we have had covid and other illness and also crash-induced injuries wiping out the majority of our riders at one stage or another in recent weeks.
`` Right now, we have very few healthy riders who could take to the start line, but they are now close contacts, and it is out of respect for the race and the rest of the peloton, that we are making this decision. It is our duty of care to the other teams to not be willingly sending riders who have been exposed to covid into a race. ''
Cyclegranny is a Twitter account well worth a follow for the chronicles of one person's experience using a bike to get around Sheffield.
`` I called this video WTF! '' they said... and it's hard to argue with that assessment... this one's WTF meets MGIF...
I called this video WTF! I don't know what she was planning but I can say there wasn't much thought there. Attempting an overtake approaching a mini roundabout and nearly causing a head on collision with another cyclist. In a hurry to get to the end of a traffic queue. pic.twitter.com/UEletk5VqT
— Cyclegranny 🚴♀️ ( @ anneramsey740) March 31, 2022
Approaching a mini roundabout which, presumably, the driver didn't see. I say presumably because the following manoeuvre would be beyond belief otherwise... With that said I 'm not sure how they 'd miss it, but maybe I 'll stick to saying what happened rather than trying to explain the unexplainable.
The WTF MGIF backs out when they see a second cyclist coming around the roundabout, you can almost see the 'oh s * * * that's a roundabout ' penny drop...
So, what would have been the reward for their speedy pass? Sitting in traffic a couple of seconds sooner, of course...
A tale as old as time... ( well, at least as old as motor vehicles)...
Dan joined road.cc as live blog editor last year. He has previously written about various sports including football and boxing for the Daily Express and covered the weird and wonderful world of non-league football for The Non-League Paper. Part of the generation inspired by the 2012 Olympics, Dan has been enjoying life on two wheels ever since and spends his weekends exploring the south of England.
My 51cm Habanero Gravel bike- 35mm Pirellis, 3T bars Selle SMP seat. Love how tough it is and amazing to ride.
And if you would like to take a little longer, go a little slower, have a little more nature and greenery and avoid some of the cloying pollution...
How can a brake disc impact a helmet seemingly perpendicular to the helmet surface? Was someone lobbing them around like shuriken?
the quotes indicates that this is the ex sponsors words.
I predict a rise in this sort of thing:... | general |
CDC will end Title 42 used to expel migrants during Covid | The Centers for Disease Control and Prevention will lift a sweeping public health order that has allowed the U.S. to expel more than 1.7 million migrants, overwhelmingly at the southern border, since the Covid-19 pandemic began.
In a statement Friday, the CDC said it will lift the order on May 23 to give the Department of Homeland Security time to scale up a program to provide vaccinations to migrants crossing into the U.S. CDC Director Dr. Rochelle Walensky determined the order was no longer necessary after reviewing current public health conditions, agency spokesperson Kristen Nordlund said.
The Trump administration first instituted the order in March 2020 under a public health law known as Title 42 to stop the spread of Covid-19 across the nation's land borders with Mexico and Canada.
However, human rights groups have denounced Title 42 as a blanket deportation policy that deprives people the right to apply for asylum under U.S. and international law. The overwhelming majority of the deportations have occurred during the Biden administration.
The CDC under Biden extended the order in August as the delta variant swept the world, but made an exception for unaccompanied children. In January, the CDC decided to keep order in place as the omicron variant caused an unprecedented wave of infection.
Last year, dozens of leading health experts from across the U.S. condemned Title 42 as `` discriminatory and unjustifiable '' with `` no scientific basis as a public health measure. '' They called on Walensky and Health and Human Services Secretary Xavier Becerra to rescind the policy. They argued that the U.S. can preserve public health and meet its humanitarian obligations by implementing masking and testing, and offering vaccination at the border.
A top lawyer at the State Department, Harold Koh, wrote a scathing internal memo criticizing the Biden policy as `` inhumane '' and `` illegal '' when he left the administration in October.
Leading Democrats including Senate Majority Leader Chuck Schumer have repeatedly called on Biden to rescind Title 42. Republicans and conservative Democrats want the policy to remain in place as the Department of Homeland Security prepares for significant increase of border crossings.
Sen. Joe Manchin, D-W.V., asked Walensky in a letter this week to extend Title 42 as the more contagious omicron BA.2 subvariant spreads around the world. Sen. Kyrsten Sinema of Arizona, which shares a long border with Mexico, also supports keeping the order in place.
The CDC is easing public health measures as Covid infections and hospitalizations have plummeted more than 90% since the peak of the omicron surge in January. The public health agency ended its warning system for cruise ships this week.
The CDC on Friday said 97% of people in the U.S. live in counties where they no longer need to wear a mask.
Read CNBC's latest global coverage of the Covid pandemic: | business |
Jobs report March 2022: Payrolls rose 431,000 in March, less than expected | Amid soaring inflation and worries about a looming recession, the U.S. economy added slightly fewer jobs than expected in March as the labor market grew increasingly tighter.
Nonfarm payrolls expanded by 431,000 for the month, while the unemployment rate was 3.6%, the Bureau of Labor Statistics reported Friday. Economists surveyed by Dow Jones had been looking for 490,000 on payrolls and 3.7% for the jobless level.
An alternative measure of unemployment, which includes discouraged workers and those holding part-time jobs for economic reasons fell to a seasonally adjusted 6.9%, down 0.3 percentage point from the previous month.
The moves in the jobless metrics came as the labor force participation rate increased one-tenth of a percentage point to 62.4%, to within 1 point of its pre-pandemic level in February 2020. The labor force grew by 418,000 workers and is now within 174,000 of the pre-pandemic state.
Average hourly earnings, a closely watched inflation metric, increased 0.4% on the month, in line with expectations. On a 12-month basis, pay rose nearly 5.6%, just above the estimate. The average work week, which figures into productivity, edged down by 0.1 hour to 34.6 hours.
`` All in all, nothing shocking about this report. There was nothing that was really surprising, '' said Simona Mocuta, chief economist at State Street Global Advisors. `` Even if this report came in at zero, I would still say this is a very healthy labor market. ''
As has been the case through much of the Covid pandemic era, leisure and hospitality led job creation with a gain of 112,000.
Professional and business services contributed 102,000 to the total, while retail was up 49,000 and manufacturing added 38,000. Other sectors reporting gains included social assistance ( 25,000), construction ( 19,000) and financial activities ( 16,000).
The survey of households painted an even more optimistic picture, showing a total employment gain of 736,000. That brought the total employment level within 408,000 of where it stood pre-pandemic.
Revisions from prior months also were strong. January's total rose 23,000 to 504,000, while February was revised up to 750,000 compared with the initial count of 678,000. For the first quarter, job growth totaled 1.685 million, an average of nearly 562,000.
Among individual groups, the Black unemployment rate fell 0.4 percentage point to 6.2%, while the rate for Asians declined to 2.8% and to 4.2% for Hispanics.
The numbers come with the economy at a critical juncture in its pandemic recovery phase. Though hiring on the top line has been strong, there remains a gap of about 5 million more job openings than available workers.
Growth as measured by gross domestic product is expected to be minimal in the first quarter. An inventory rebuild last year that helped propel the biggest yearly gain since 1984 is tapering, and multiple factors kept advancements in check to start 2022.
The biggest attention-getter has been inflation, running at its fastest pace since the early 1980s and helping constrain consumer spending as wage gains haven't been able to keep up with prices. At the same time, the war in Ukraine has dampened sentiment and added to supply chain issues. And rising interest rates are showing signs of slowing the red-hot housing market.
To combat inflation, the Federal Reserve is planning a series of interest rate hikes that further would slow growth.
Markets now are anticipating rate increases at each of the six remaining Fed meetings this year, likely starting with a half percentage-point move in May and continuing to total 2.5 percentage points before 2022 comes to a close.
There was little in Friday's report that would alter that outlook.
`` The wage picture is critical, '' said Mocuta, the State Street economist. `` The report doesn't really change the short-term trajectory, the idea that we're going to get a few hikes in a row. If indeed you get confirmation that the wage growth is slowing at the margins, that maybe allows the Fed to reassess. ''
The hospitality industry has been among the hardest hit during the pandemic. While hiring has continued at restaurants, bars, hotels and the like, challenges remain.
Some 90,000 establishments closed in 2021, while sales were off about 7.5% from pre-pandemic levels, according to the National Restaurant Association. The industry remains about 1.5 million jobs below the February 2020 level, with an unemployment rate that nevertheless tumbled to 5.9% in March, down 0.7 percentage point from the previous month.
Dirk Izzo, president and general manager of NCR Hospitality, said the industry is using a variety of tactics to survive. Technology has been a big factor in the pandemic world, with companies coping with a lack of workers by turning to hand-held devices, QR-coded menus and other implements to improve customer service.
`` We're saying that they're having a really hard time staffing fully both the front of the house and the back of the house, '' Izzo said. `` They 've actually taken tables out of the restaurants because they can't find the staff. ''
Establishments that have run out of government subsidies are shutting down, while those remaining open are having to raise prices to combat inflation.
Nevertheless, he said there's an air of optimism that with the pandemic easing and people returning to their regular behaviors, the industry can rebound.
`` I think people are going to come back from this stronger than before, '' Izzo said. `` They're going to have to put more technology in. I do think it's going to be a positive for the industry. It's just going to be a bumpy road. '' | business |
NASA begins critical final test on mega Moon rocket | Hi, what are you looking for?
NASA on Friday begins a critical two-day-long test of its giant Space Launch System ( SLS) rocket complete with a mock countdown.
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NASA on Friday begins a critical two-day-long test of its giant Space Launch System ( SLS) rocket complete with a mock countdown, as the agency gears up to return humans to the Moon.
Known as the “ wet dress rehearsal, ” it is the final major test before the Artemis-1 mission this summer: an uncrewed lunar flight that will eventually be followed by boots on the ground, likely no sooner than 2026.
“ It is our last design verification prior to our launch, ” senior NASA official Tom Whitmeyer said in a call with reporters this week.
Data collected from the test will be used to finalize a date for Artemis-1 — NASA had said May could be the first window, but later now seems likely.
It is called a “ wet ” dress rehearsal because super-cooled liquid hydrogen and liquid oxygen will be loaded into SLS from ground systems, just as they would be in a real launch.
The 322 feet ( 98 meters) tall rocket — expected to be the most powerful in history at the time it is operational — was rolled out to Launch Complex 39B at the Kennedy Space Center in Florida around two weeks ago.
The test begins at 5:00 pm Eastern Time ( 2100 GMT) with a “ call to stations, ” as members of the launch control team arrive at their firing rooms and start a countdown of more than 45 hours.
With the SLS rocket and Orion crew capsule fixed on top powered on, teams will proceed to load 700,000 gallons ( 3.2 million liters) of propellant, and practice procedures such as pauses in countdown and other checks.
They won’ t actually ignite the rocket’ s RS-25 engines, which were tested previously. Instead they will halt the countdown about 10 seconds before liftoff, in order to simulate a “ scrub, ” when launch is aborted due to technical or weather related issues.
The fuel will be drained, and a few days later SLS and Orion will be rolled back to the vehicle assembly building to carry out checks on how everything went.
Test milestones will be posted on NASA’ s blog for the Artemis mission, but the agency won’ t let the public listen to live internal audio, as it did in the past for Space Shuttle missions.
Whitmeyer explained this was because certain key information, including timing sequences, could assist other countries looking to develop long range missiles.
“ We’ re really, really super sensitive to cryogenic launch vehicles that are of this size and capability, ( and) are very analogous to ballistic type capabilities that our countries are very interested in, ” he said, but added that the agency could re-evaluate the position in future.
With 2,400 staff representing 100 different nationalities, AFP covers the world as a leading global news agency. AFP provides fast, comprehensive and verified coverage of the issues affecting our daily lives.
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National gymnasts successfully perform at FIG Artistic Gymnastics World [ PHOTO ] | Azerbaijani gymnasts have successfully performed on the second day of the FIG Artistic Gymnastics World Cup.
Ivan Tikhonov scored 13.366 points and ranked sixth in the crossbar exercises.
Samira Gahramanova and Milana Minakovskaya performed beam exercises. Milana Minakovskaya received 10.300 points and took the 20th position. Samira Gahramanova got 10.100 points and took the 22nd place.
Earlier, the gymnasts performed floor exercises. Samira Gahramanova received 11.566 points and at the moment she is in fifth intermediate place. Milana Minakovskaya took the seventh intermediate position with 10.600 points.
After three competitions of the World Cup held in different countries, the World Cup in Baku is considered to be the final stage. Three best results out of four will define the holders of the FIG Cup in separate apparatus.
The qualifications will run from March 31 to April 1 while the finals are scheduled for April 2-3.
The AGF Trophy will be presented to the gymnasts who received the highest scores.
The participants of the World Cup in Baku include such well-known athletes as Croatian gymnast, silver medalist of the Olympic Games Beijing-2008, European and World Championships Ude Filip, Turkish gymnast, bronze medalist of the Summer Olympic Games Tokyo-2020, bronze medalist of the European Games, two-time winner of the European Championships Arican Ferhat, winners and prize-winners of the World and European Championships Matvey Petrov ( Albania), Hoeck Vinzenz ( Austria), Fraser Joe ( UK), Tvorogal Robert ( Lithuania) and others.
Azerbaijan is represented at the World Cup by Mansum Safarov ( floor), Aghamurad Gahramanov ( Floor, Vault, Parallel Bars, Horizontal Bar), Ivan Tikhonov ( Pommel Horse, Vault, Horizontal Bar), Javidan Babayev ( Rings), Nikita Simonov ( Rings), Samira Gahramanova ( Vault, Balance Beam, Floor), Milana Minakovskaya ( Uneven Bars, Balance Beam, Floor).
Tickets can be purchased at the iTicket.az and all ticket offices. Tickets cost 7 AZN ( $ 4) for qualifications and 12 AZN ( $ 7) for finals.
Spectators under 18 must have a valid COVID-19 vaccine certificate, immunity certificate or COVID-19 vaccine medical contraindication form. | general |
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