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Topline

Despite international aid efforts ramping up, the second wave of Covid-19 infections in India continues to intensify, yielding a new record high for daily deaths on Sunday and prompting an outcry—from businessmen and public officials alike—for government intervention to help ease the rate of infection.

Key Facts

In a Sunday statement for the Confederation of Indian Industry, Indian billionaire Uday Kotak called on increased lockdown measures in India and urged “the strongest national steps, including curtailing economic activity, to reduce suffering.”

India’s Ministry of Health and Family Welfare reported 3,689 new Covid-19 deaths Sunday, marking the nation’s largest daily death toll yet and bringing the total number of Covid-19 deaths in the country to more than 215,000.

The country also reported 392,488 new cases Sunday, down from a record high of 401,993 reported Saturday but still the second-highest daily tally on record for any country around the world.

Meanwhile, India’s death and infection rates continue to outpace its rate of vaccination: Roughly 157 million vaccines have been administered in the country, up just 1.2% Sunday, and despite India being the world’s leading producer of vaccines, only 2% of its population has been fully inoculated due largely to high vaccine prices and a large impoverished population.

“Enough is enough,” the High Court of Delhi said Saturday as it directed the nation’s central government—which has been criticized for its lackluster pandemic response—to supply oxygen to India’s capital territory of Delhi, warning officials that it may initiate contempt of court proceedings if the order is not implemented.

“The hospitals are full,” Germany’s Ambassador to India, Walter J Lindner, said late Saturday while delivering ventilators to New Delhi, adding that people are sometimes dying in front of hospitals and in their cars because they have no oxygen.

Crucial Quote 

“At this critical juncture when [the] toll of lives is rising… safeguarding lives is of utmost priority and nationwide maximal response measures at the highest level [must be] called for to cut the transmission links,” Kotak said Sunday. “We must heed expert advice on this subject—from India and abroad.”

Key Background

For roughly two weeks, a second wave of the pandemic has intensified in India—overwhelming hospitals, exhausting the nation’s vaccine supply and making the country the biggest Covid-19 hotspot in the world. Many are blaming India’s ruling party for the outbreak, saying Prime Minister Narendra Modi campaigned aggressively for crucial state elections while failing to impose measures to help prevent a pandemic outbreak. Now starting to trickle in, election results are pointing to an overwhelming defeat for Modi’s party. “Evidently something went wrong, evidently we were hit by a tsunami,” Narendra Taneja, a spokesperson for India’s ruling party, told CNN last week. “We know we’re in power, we are responsible… our focus is now on how we can save lives.” So far, only six of India’s 29 states have imposed some form of Covid-19 lockdown during the new wave of infections.

Surprising Fact

According to an early Sunday report by Reuters, Indian officials ignored a forum of scientific advisors in early March who warned of a more contagious Covid-19 variant rapidly spreading around the country. Despite the calls for increased lockdown measures, officials instead held large political rallies attended by millions of maskless people ahead of the elections, Reuters reported.

Big Number

19.6 million. That’s how many Covid-19 cases have been reported in India through Sunday—the second-most among countries and behind only the United States’ count of 32.4 million.

Tangent

Speaking to CBS’ Face the Nation Sunday morning, White House Chief of Staff Ron Klain said the U.S. is “rushing aid” to India, including therapeutics, ventilators, personal protective equipment and rapid diagnostic tests. The U.S. is also looking to send over a portion of already purchased AstraZeneca vaccines.

Further Reading

India hits new grim record with 3,689 COVID-19 deaths in one day (Al Jazeera)

Photos Show The Distressing Severity Of India’s Covid-19 Crisis (Forbes)

India’s Daily Covid Cases Soar Past 400,000 As Crisis Deepens (Forbes) 

Enough is enough, ensure oxygen supply, Delhi High Court directs Centre (Tribune India)

Oops, Joe Rogan did it again. While it’s not fair to characterize Rogan as “anti-vaxx,” he did repeat a misconception about the Covid-19 vaccine. Not once but twice.

Back on the April 23 episode of his popular Spotify podcast “The Joe Rogan Experience,” Rogan had said, “I’ve said, yeah, I think for the most part it’s safe to get vaccinated. I do. I do. But if you’re like 21 years old, and you say to me, should I get vaccinated? I’ll go no.” The following tweet included a clip of what Rogan, a comedian, podcaster, and Ultimate Fighting Championship (UFC) commentator, had said:

Oh, no, Joe. Say it isn’t so. Rogan’s statement didn’t quite mesh with the following Centers for Disease Control and Prevention (CDC) statement: “Everyone 16 years of age and older is now eligible to get a COVID-19 vaccination. Get a COVID-19 vaccine as soon as you can. Widespread vaccination is a critical tool to help stop the pandemic.”

Not surprisingly, Rogan got push-back from public health experts for this statement, because suggesting to the public that there’s no reason for young and healthy people to get the Covid-19 vaccine is wrong, wrong like a bedroom gong. Young and healthy people are not invulnerable. They can still get infected by the Covid-19 coronavirus. They can still get Covid-19. Some can get very sick with Covid-19. They can still pass the virus on to others when they are not vaccinated. That’s essentially what Anthony Fauci, MD, the Director of the National Institute for Allergy and Infectious Diseases (NIAID), emphasized on the Today show when asked to comment about what Rogan had said:

OK, Fauci didn’t use the words “bedroom gong.” But he did use the word “vacuum,” as when you think that you don’t need to get vaccinated because you are young and healthy, “you’re talking about yourself in a vacuum then.” And he wasn’t referring to the “suck up dust and truffle bits” type of vacuum but rather the “only thinking about yourself” type of vacuum.

As a result of the push-back, on the April 29 episode of his podcast, Rogan tried to clarify what he had said the week before, emphasizing that “I’m not an anti-vaxx person,” and that “in fact, I said I believe they’re safe and I encourage many people to take them. My parents were vaccinated.” Indeed, calling Rogan an “anti-vaxxer” or describing his previous comments as “anti-vaccination” would be going a bit too far. Someone who is “anti-vaxx” is actively trying to get others to not get vaccinated often by spreading misinformation. That didn’t seem to be what Rogan has been doing.

But then Rogan did add, “I just said I don’t think if you’re a young healthy person you need it,” as you can see in following video:

Joe close, yet Joe far away.

As a reminder, Rogan is not a medical doctor, which comedian Bill Burr has pointed out on a previous show:

And to be fair, Rogan has never claimed to be a medical doctor. In fact recently, Rogan did re-iterate, “I’m not a doctor, I’m a bleeping moron. I’m not a respected source of information, even for me.” Note, Rogan didn’t actually say the word bleeping but instead said something that begins with the letter “f” and wasn’t “floccinaucinihilipilification.”

Nevertheless, Rogan does have quite a megaphone at his hands. According to Natalie Jarvey writing for The Hollywood Reporter, The Joe Rogan Experience was Spotify’s most popular podcast in 2020. The show’s YouTube channel has at least 10.6 million subscribers. So what he says, even if it is about a topic that’s beyond his expertise, may get traction among his viewers and listeners. These days, if you are famous for one thing, people may assume that you know a lot about everything. This is true even though getting medical or public health advice from a movie, TV, or podcast stars who aren’t medical doctors makes about as much sense as having Kim Kardashian or Justin Bieber play quarterback for your NFL team.

Rogan’s comments did reveal a continuing widespread misconception about the Covid-19 vaccination program. It isn’t just all about you. The Covid-19 vaccine isn’t a gigantic concrete full body condom. Your risk of catching the virus and getting sick from Covid-19 depends on not only whether you get the vaccine but also whether other people around you get the vaccine. As long as the virus can find more people to infect, it will keep spreading. The longer and further it can spread, the more opportunities the virus may have to mutate, potentially into something more contagious and even more deadly. Just because young, healthy folks seem to have had a lower probability of getting very sick from Covid-19, who knows what may happen in the future.

In fact, as Peter Hotez, MD, PhD, Dean of the National School of Tropical Medicine at the Baylor College of Medicine tweeted, recently more and more younger folks have been getting sicker with Covid-19:

By the way, Covid-19 expertise does not seem to be in the Liz Wheeler-house.

Plus, younger, healthier folks may be more likely to spread the virus. They may be more likely to go to bars and yell stuff like “YOLO” at the top of their lungs, spewing virus all over the place if they are infected. They may be more likely to travel to different locations and mix with more people. That’s why getting the younger and the healthier vaccinated is critical to stopping the pandemic.

The longer it takes for our society to reach the herd immunity thresholds needed to really slow the spread of the virus, the longer our society will have to keep talking about social distancing and face mask wearing. Therefore, the more that such scientific facts can get out there, the better, so that people understand how important it is to encourage each other to get vaccinated. And Rogan can help do this by getting more real medical and public health experts on his show. After all, Rogan isn’t your average Joe.

When President Biden addressed Congress this week, he didn’t have much to say about healthcare reform. The one exception was the President offering a vague proposal to grant Medicare negotiating power regarding prescription drugs prices: “Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower prices for prescription drugs.” Details were left to the imagination. Would this be through some version of H.R. 3, the bill co-sponsored by Speaker of the House, Pelosi, which would introduce price controls through international reference pricing for certain drugs? Or, would it simply mean giving Medicare the ability to negotiate drug prices as a single entity? The President went on to say that the “money we save [from lower drug prices] can go to strengthen the Affordable Care Act and expand Medicare coverage and benefits.” Once more, Biden provided no further elaboration on what is implied by “expansion of Medicare coverage.” Perhaps lowering the age of eligibility? Maybe. But we don’t know.

What we do know, however, from the Biden Administration’s actions in recent months is that the push to expand Medicaid is in full swing, particularly in the 12 states that have not yet added to their rolls. And it’s not just one-off pronouncements. Under the Affordable Care Act (ACA), the federal government already covers 90% of states’ costs of Medicaid expansion. Additionally, the American Rescue Plan Act, enacted in March, substantially sweetened the deal by providing a supplemental financial incentive for the 12 states that hitherto have not expanded Medicaid Specifically, states would become eligible for a five percentage point increase in the federal government’s match rate – the percentage of costs of the state’s Medicaid program that the federal government incurs – for the next two years if they implement expansion.

Here, the Biden Administration is attempting to reduce the levels of uninsured by offering lucrative incentives to the 12 states that have resisted expanding Medicaid. Across these 12 states, 2.2 million uninsured people with incomes below poverty lack affordable healthcare options. They earn too much income to be eligible for Medicaid in their state, but not enough to qualify for financial subsidies to purchase ACA exchange health insurance.

In April, the Biden Administration rescinded approval of a 10-year extension of a Texas Medicaid demonstration project involving so-called “uncompensated care pools.” After enactment of the ACA, the Centers for Medicare and Medicaid Services had approved uncompensated care pools, but sought to phase them out, favoring Medicaid expansion instead. The Trump administration reversed course and allowed uncompensated care pool funding to substitute for coverage.

During its final weeks in power, the Trump administration approved 10-year extensions of Section 1115 Medicaid waivers for demonstration projects in Florida, Tennessee, and Texas — three states that have not expanded Medicaid under the ACA. These waivers have been used to allow states to draw down Medicaid funds to pay hospitals for care provided to the uninsured. The uncompensated care pools can play a meaningful role in defraying costs associated with treating people who lack access to affordable coverage.

The renewed Section 1115 waivers were approved on January 15, 2021, for an unprecedented 10 years, as opposed to five, which had been the convention. The Trump administration even ignored public notice requirements to approve the Texas waiver extension.

In revoking the Texas waivers, the Biden Administration appears to be signaling that the demonstration project strayed too far from Medicaid’s original purpose of providing comprehensive access to the Medicaid-eligible with the full range of healthcare benefits.

In the case of Texas, if the state were to expand Medicaid, the federal government would increase its matching rate reimbursement from 62% to 67% of all Medicaid expenditures. Furthermore, the federal government would pay 95% of the costs for the estimated 1.4 million adults who would become newly eligible for the Medicaid program.

The uncompensated care pool programs are relatively inefficient mechanisms of access. The programs’ narrow focus on hospital cost coverage in lieu of a broad set of healthcare services disregards the role of preventive and maintenance care. Indeed, comprehensive Medicaid coverage could have helped avoid costly emergency room visits and inpatient admissions in the first place. For this reason, among others, hospitals have continued to press for Medicaid expansion.

In the end, paying for an emergency room visit or inpatient care is no substitute for coverage that provides access to the full array of healthcare benefits, including primary and specialty care, diagnostic tests, prescription drugs, and other healthcare services to treat and manage acute and chronic illnesses and conditions.

It appears politics, not public opinion, explains why the 12 holdout states aren’t budging. Most voters in the 12 states want Medicaid expansion. But because Medicaid expansion is a key provision in the ACA, opposition endures. Ostensibly, a number of Republicans leaders balk at the cost of Medicaid expansion. However, given the latest inducements offered through the federal stimulus package that argument doesn’t stand up, at least not in the short term.

Episodes of nausea, sweating, fainting and a handful of other symptoms in individuals after having the Johnson & Johnson/Janssen Covid-19 vaccine prompted an investigation by the CDC last month. The clusters, which occurred at mass vaccination sites in California, Colorado, Georgia, Iowa, and North Carolina were apparently alarming enough that four of the five sites closed temporarily while the analysis took place. But yesterday, the CDC released a report confirming that the episodes were not the result of the vaccine itself, but rather people’s anxiety about it. The reactions are still “real” physiological reactions, but luckily, have nothing to do with any component of the vaccine.

According to the research, there were 64 cases of anxiety-related events out of 8,624 people who received the vaccination in the five sites from April 7-9, but none met the definition of “serious”: they included light-headedness or dizziness (56%), pallor or excessive sweating (31%), fainting (27%), nausea or vomiting (25%), and low blood pressure (16%). The median age of the individuals who experienced the events was 36 years and 61% were women. Interestingly, the cases in four of the five sites occurred on the sites’ first day of administering vaccines.

Everyone recovered quickly—within 15 minutes at the vaccination site or, for the 13 people who were moved to the hospital, the same day. About a quarter of the total number affected reported also having had similar events after vaccination in the past.

In addition to looking into these smaller clusters, the CDC also looked at instances of fainting in all 7.98 million people who received the Janssen Covid-19 vaccine from early March to early April, and found a rate of 8.2 per 100,000 doses. By contrast, for flu vaccines over the course of a full year, the rate was 0.05 per 100,000, which makes the reaction about 164 times more common for the Janssen Covid-19 vaccine than for the flu vaccine. For both, the reaction was more common in people aged 18-29.

So, perhaps not surprisingly, there seems to be something about the Covid-19 vaccine that engenders anxiety. The CDC report points out that people receiving the Janssen vaccine may have sought it out because it only involves one shot, so may be a self-selecting group of people more prone to having an anxiety response.

They write, “it is possible that some persons seeking Janssen COVID-19 vaccination could be more highly predisposed to anxiety-related events after being vaccinated. The stress of an ongoing pandemic might also increase anxiety surrounding COVID-19 vaccination. In addition, in mass vaccination situations, an anxiety-related event witnessed by others on-site or reported through media coverage might provoke additional anxiety-induced episodes.”

In other words, observing a fainting episode either in person or vicariously through stories or social media, may trigger a chain reaction. The physiological reaction itself is known as the vasovagal response, which occurs when an emotionally charged event (like the sight of blood or an approaching needle) triggers the vagus nerve to set off a chain of events, including a drop in blood pressure and fainting or near-fainting. The cluster part is trickier to explain, but such psychogenic group events have been recorded fairly regularly in the past, and probably involve a combination of conscious, subconscious, and neurophysiological mechanisms.

It’s important to point out that the recent clusters of anxiety-triggered reactions occurred before the reports of the rare blood clotting side effect (thrombosis with thrombocytopenia syndrome) that briefly paused the Janssen vaccine last month. It will be interesting to monitor the rate of anxiety-based reactions over time—and see whether similar reactions are tied to the other available Covid-19 vaccines.

In the meantime, the CDC asks healthcare professionals to be aware of the risk of anxiety-based reactions in their patients, and recommends that, like the watch-period for serious allergic reactions to the vaccines, patients be watched for 15 minutes after receiving the shot. If nothing else, the CDC investigation and report is another sign of the close attention given to patient safety during this vaccine rollout—and should be a reassurance that events, even innocuous ones, are being taken seriously and handled swiftly.

First it was toilet paper. Next, it was disinfectants, followed by face masks and other personal protective equipment. Then, it was a whole array of different items, ranging from yeast to condoms to kettlebells to jigsaw puzzles to aluminum cans, not that all of these items are necessarily used together at the same time. Now the latest shortage that the U.S. is facing is, let’s pool our guesses together: chlorine.

Yep, throughout much of 2020, it seemed like every month another household product was in short supply. Things that you had assumed would always be available suddenly disappeared from store shelves and online sites. Often, the shortages occurred simultaneously. So planning that jigsaw puzzle, bread baking, and condom theme party could have been challenging. At times, last year, it may have felt like the only thing not in short supply was angst. After all, the Covid-19 coronavirus pandemic essentially ripped the cover off of many existing weak links in our society, including deficient supply chains, like you might rip the plastic packaging off of a One Direction figurine box.

The latest shortage is chlorine, which can come in the form of tablets, powders, and liquids. Chlorination may sound like something you do when you put a crown or tiara on someone’s head. But instead it is the process of putting the right amounts of chlorine in a swimming pool, a hot tub, a jacuzzi, or basically any similar container of water where your hot bod may go. Chlorine is important because swimming pools and similar receptacles can otherwise be filled with algae and dangerous microbes like cryptosporidium, legionella, and brain-eating amoeba. In general, it’s a good idea to stay from anything that has the words “brain-eating” such as brain-eating politician, brain-eating cat, or brain-eating pizza.

The shortage appears to be the result of two issues. One is that the pandemic has seemed to boost demand for chlorine. This is hopefully not because people are injecting and ingesting chlorine. You should never inject or ingest any such cleaning material. Instead, the increased demand may be due to the pandemic limiting some traditional indoor recreational options like standing in a crowded bar yelling “dude”, “wooo”, “YOLO”, and “what the bleep did you just say” to each other. As a result, folks may be opting for other at-home or outdoors recreational activities such as using swimming pools and sitting in jacuzzis while yelling “dude”, “wooo”, and “YOLO” at each other.

The other issue is supply. As reported by Liz Hampton and Jessica Resnick-Aultright for Reuters last August, the Biolab Lake Charles facility in Louisiana erupted into flames after Hurricane Laura hit. This led to the shutdown of one of the major chlorine suppliers until the spring 2022, leaving only two current manufacturers of chlorine tablets in the U.S.: Occidental Petroleum and Clearon Corporation.

Relying on just three suppliers for anything is risky, which is essentially what happens when industries move more towards monopolies. Imagine being told that you only have three options of dates: the guy who posted the shirtless selfie while holding a fish in his hand, the guy who posted the shirtless selfie while holding the even bigger fish in his hand, or the guy who posted the shirtless selfie but forgot the fish. Or perhaps the woman who wants you to be shirtless and hold a fish in your hand, the woman who wants you to be holding an even bigger fish, or the woman who is holding a picture of a guy who is shirtless and holding a fish in his hand. Ultimately, having a greater number of options will help better maintain quality, lower prices, redundancy should demand increase, and the possibility of dating someone who doesn’t post shirtless selfies.

All of this means that chlorine prices will probably jump up and anyone with a swimming pool, a hot tub, a jacuzzi, or a water park may not be able to get all the chlorine that they want or need. Therefore, be extra cautious before entering any such recreational water area that you yourself have not maintained because the operator could be skimping on the chlorine. Check to see if the water looks dirty or if insects seem to be having a “gender reveal” party on the water. Certainly if a mass of algae in the pool asks you “how you doing,” the water probably does not have enough chlorine in it. Make sure that the pool, tub, or water park is being regularly inspected by officials (and not just hedgehogs and squirrels) and has a proper filtration and cleaning system in place.

Moreover, do what you can to keep the pool or tub clean. More dirt and contaminants may mean more chlorine is needed. So, try to shower before entering the pool or tub. This may not be the best time for that “One Hundred People in a Hot Tub” party. Or to invite that “Showering is a hoax” guy into the swimming pool. Keep other animals like dogs, cats, and honey badgers out of the tub or pool. They can carry even more microbes because they essentially run around naked all the time without showering.

You may want to consider alternatives to using chlorine. Of course, one of the alternatives should not be, “don’t use anything” or “use ketchup instead.” There are other options such as saltwater, ultraviolet (UV) light, and other systems to keep things clean. However, just because someone comes up with a fancy name like “Jar Dabs” for a pool cleaning system doesn’t mean that it actually works. Don’t try any new system without first consulting with real swimming pool professionals. It’s not a great idea to experiment on yourself and others with a new system and then ask everyone afterwards, “hey, that was some fun time in the pool, right? By the way, how are your eyes, ears, and intestines doing?” Even worse, you don’t want to end up in the emergency room, saying, “guess that cleaning system didn’t really work on microbes.”

“Fake it till you make it” can be very questionable advice. “Fake a Covid-19 vaccination card because you can’t make a vaccination appointment” can be even worse.

As I have covered previously for Forbes, a Covid-19 Vaccination Record Card is currently the only real proof that you’ve received the Covid-19 vaccine. In order to get a real version of this cardboard paper card, you have to, you know, actually get the Covid-19 vaccine. So when schools, businesses, and other organizations want to determine who’s really been vaccinated, all they have to do is check for people’s vaccination record cards, because no one lies and cheats in our society, correct?

Well, as you’ve probably seen, for every rule, requirement, or standard, there’s no shortage of people who are willing to break it. Whether it’s resumes, college applications, Avengers membership cards, or pretty much anything else, you’ll find at least some people trying to fake it. So it shouldn’t be a surprise to hear that people have been circulating instructions and means to create fake Covid-19 Vaccination Record Cards. Kevin Collier and Ben Collins reported for NBC News that such instructions and templates have appeared on “pro-Trump forums, like TheDonald.win, which was rebranded to Patriots.Win”, “the extremist forum 4chan”, and “QAnon forums.” Joseph Cox wrote an article for Vice entitled, “I Bought a Fake Covid-19 Vaccine Card on Etsy,” because that’s essentially what he was able to do pretty easily.

The Department of Health and Human Services, Office of Inspector General (HHS-OIG) and the FBI have noticed that such cards have been “advertised on social media websites, as well as e-commerce platforms and blogs,” and issued a stern warning about them: “If you did not receive the vaccine, do not buy fake vaccine cards, do not make your own vaccine cards, and do not fill-in blank vaccination record cards with false information.” In this case, FBI stands for Federal Bureau of Investigation and not Fun Bits Interactive or Fungi, Bacteria, and Insects. When the FBI gets involved, you know that the words “breaking the law” or “oh bleep” may not be too far away. Indeed, the FBI warning says, “the unauthorized use of an official government agency’s seal (such as HHS or the Centers for Disease Control and Prevention (CDC)) is a crime, and may be punishable under Title 18 United States Code, Section 1017, and other applicable laws.”

Here’s a tweet about this from the FBI Knoxville, which is Knoxville, Tennessee, and not Johnny Knoxville:

Seena Gressin, an Attorney at the Federal Trade Commission (FTC) has also warned against posting pictures of your Covid-19 Vaccination Record Card. That’s because, surprise, surprise, people may download your picture and use it and the accompanying information. In this case, the risk is greater than your face appearing on a donkey’s body or on someone’s dating profile. They can use it to create a fake Covid-19 Vaccination Record Card or steal your identity as the following tweet warned:

Remember as is the case with many types of cheating, such fraud greatly affects those who actually play by the rules. For example, what about Centers for Disease Control and Prevention (CDC) guidance for fully vaccinated people like you can now “gather indoors with fully vaccinated people without wearing a mask or staying 6 feet apart?” If people aren’t being truthful about whether they are vaccinated, in the adapted words of that song that was sung by Whitney Houston, “how will I know, how will I know (some people can be freaking deceiving about their vaccination status)” whether it’s indeed safe to not wear face masks and come within six feet or one Denzel (because Denzel Washington is about six feet tall) of others. That can makes it difficult to follow guidance that distinguishes between those fully vaccinated and those who are not as the following tweets indicated:

Keep in mind that your protection against the Covid-19 coronavirus depends on not only you getting fully vaccinated but also those around you getting fully vaccinated. The FBI warning did say, “By misrepresenting yourself as vaccinated when entering schools, mass transit, workplaces, gyms, or places of worship, you put yourself and others around you at risk of contracting Covid-19.” The vaccine is not 100% effective. Even after getting vaccinated, you can still get infected with the virus, potentially get sick, and spread the virus to others, although your chances are probably significantly lower as a result of the vaccine. These chances go even lower when those around you are fully vaccinated.

Covid-19 Vaccination Record Card fraud does beg the question as to whether a national system of tracking vaccination or vaccine passport system is needed. Such questions should have been considered prior to the Covid-19 vaccine roll-out in 2020, which initially went about as well as repeatedly hitting your forehead with a sneaker. Those wary of such systems have argued that there may be privacy and data security concerns with such systems. So this is not necessarily a straightforward matter. Unfortunately, though, those distributing and using fake Covid-19 Vaccination Record Cards are driving the need for these considerations.

Here’s a thought. If you want the benefits of getting fully vaccinated, get fully vaccinated. If you are still hesitant about getting vaccinated, keep yourself and others safe by continuing to follow all face mask wearing and social distancing guidance in the meantime. Being an adult is about making choices and those dealing with the consequences of those choices. You can’t have your cake and eat it too. Otherwise, it wouldn’t really be cake but instead could be something really weird that you shouldn’t be eating. And if you aren’t really ready to make the choice of getting vaccinated, don’t fake anything. Instead, get real medical advice from real doctors using real science. “Faking it till you make it” can be really terrible advice.

Scrolling through social media you might come across one of Galey Alix’s popular design reveals—a complete surprise renovation and redesign of a home that she does in a single weekend. After a family reaches out to her on Instagram, they leave her with their keys and their credit card for the weekend. Yes, they trust her blindly. And if you are one of her almost 4 million followers on TikTok and Instagram (and counting), you might already know this isn’t her full time job. Galey is an executive at Goldman Sachs based out of Florida. Because of her day job, she has to fit all of her home renovations into a 72-hour-turnaround each weekend. When Monday morning comes, she’s back at work… perfectly timed with Wall Street’s opening bell.

Though it might seem like Galey is exactly where she belongs, this is not at all where she imagined her life would be. In fact, she was supposed to be married right now and living in her dream home in Connecticut. A home she purchased with her then fiancé and spent every weekend for a year flying to and from Florida to work on by herself. Once she finished their 10,000 square foot home, she planned to leave Goldman (a career she loved), while also parting with her life, home, and family in Florida in pursuit of starting a new one with her new husband. 

At the time, Galey thought her life was great, maybe even perfect, but what she was showing on social media was not her true reality. She says, “I honestly believed I was living my dream life, just like I portrayed on Instagram. I had this handsome fiancé, a successful career on Wall Street, a beautiful home and cute dogs and, you know, life is perfect. But deep down, I was dying with my eyes wide open.” 

Just weeks before her wedding, Galey revealed the truth behind her internal battle to the one person she thought she could trust. A battle she had never addressed out loud before, even to herself. She told her then fiancé that she had been struggling with an eating disorder and needed help finding a local therapist. Galey explains that it got to a point where felt she would die from her eating disorder, internal angst, or from depression, so she had to do something. She believed at the time, “I don’t know which is going to get me first, but if I don’t do something about this [now], I’m not going to be here much longer.”

Instead of receiving comfort or support, her then fiancé responded by asking her how she could do this to him and how she could “get sick and still let him love her.” He felt like she had been lying to him, which Galey admits she had of course been lying, “because I was lying to myself, too. I kept telling myself everything was great. I had it all under control. I didn’t.”

No less than an hour after this conversation he had her pack a suitcase, get her 2 dogs, and leave on a plane home to Florida. When she landed, she became acutely aware that she couldn’t do it herself anymore. She acknowledged that what she was doing, portraying her life on social media and to loved ones as perfect despite struggling on the inside, wasn’t working. It left her without a fiancé, a job (she promised him she’d resign from Goldman before their wedding, so she did), and a home. She describes it as rock bottom, but lower. She says, “They say graves are buried 6 feet under the ground right? I felt like I was buried alive in a cave somewhere below those six feet under the ground. It was so low and so dark, I couldn’t crawl out no matter how hard I tried. I lost everything I worked for, and all at the same time.” She knew she needed to try something different.

That ‘something different’ was mental health treatment. Her only previous interaction with the mental health system was a therapist briefly in college that she went to because her mom asked her to go for her stress. This time, she went to therapy and actually put energy into it, for herself. She saw an eating disorder therapist and a nutritionist who specialized in eating disorders. She knew she needed to “tackle it head on” and went to 2-3 sessions a week for several months. She says, “I was hyper focused on how do I make sure that the next chapter in my life doesn’t end the same way the last chapter did because I never want to go back there.”

When she emerged from her treatment, she felt calmer and less of a need to control everything around her, because she no longer felt out of control. She was also able to keep her job at Goldman. This was the official start of her next chapter. And then, feeling mentally strong enough to, she finally logged back onto her social media for the first time since her breakup. It was then that she discovered the old videos she posted of her redoing her home in Connecticut had gone viral. Hundreds of strangers were privately messaging her asking for her to come fix their homes, too. She thought, “Instead of staying home and feeling sorry for myself this weekend, I should say yes to one of these kind strangers and see if that makes for a better weekend. What do I have to lose?” This was the unintentional start of her surprise-design weekend business and explosive social media growth. One might even say, the start of her personal Empire. But, perhaps most importantly, it was when she realized how much helping strangers love their homes might actually end up helping her.

She explains, “Saving their homes is actually what saved me. It made me feel like I had something to live for again. Even though I wasn’t able to get married and start a family of my own, I am instantly adopted into the families whose home I am working on. I am getting to transform their houses into that “family home” I was trying so hard to create in Connecticut for myself and my ex-fiancé, but wasn’t healthy enough to. It’s like my pain found its purpose and its purpose is to help others. And now I’ve got a healthy outlet for the creativity I’ve always had burning inside me but never unlocked.” Without realizing it, this became her new therapy.

You wouldn’t know it looking at her finished products, but Galey has no design experience, has never watched a design television show, nor had a Pinterest account. Her childhood habits, however, speak volumes. For example, she tells a story about how she would play with Lincoln Logs not by actually playing with them but by stacking them, color coordinating them by length and width in their bin, and then organizing the rest of the toy closet so it would look “pretty” when she set the bin back where it belonged. She played by organizing her toys and then putting them away, always in an aesthetically pleasing way. From a young age, designing presented itself as an outlet for her perfectionism, and a healthy one at that. 

Galey explains, “It allows me to take the weight off of trying to pick myself apart and make myself perfect. Today, I put all the energy I was putting into tearing myself apart into picking a room apart because that I can get perfect.” This has been particularly helpful in the pandemic, which would otherwise be very isolating for a single person, leaving her alone with just the thoughts in her head, void of distractions. 

The surprise reveal (the moment she reveals the newly renovated home to the trusting homeowner on Sundays) also helps her mental health. She says sometimes she even looks happier than the homeowners in her reveal videos. She explains, “I am just so grateful to be alive and having that experience with them, in that moment. I’m getting to witness seeing someone genuinely happy first-hand. This is how I started finding my self-worth and my value again. How I started believing I am worthy of being kind to my body, taking care of myself, and most of all, that I do have something worth living for.” 

Today, Galey has fixed over 100 spaces for dozens of clients and now she is averaging over 10,000 design requests every 7 days. About a year ago she booked 5 years worth of clients and stopped taking on new projects. However, Galey’s clients believe she is worth the wait and from every satisfied customer, it is clear they are right.

Being in such a different place and feeling healthier and more aware of her own mental health struggles, she has also realized that part of what she can do is use her social media influence for good—making it about helping people and her passions and not about airbrushing and photoshop. That’s one reason why you will only ever see her wearing a baseball cap and mostly T-shirts; she wants the focus to be on what she creates, not how she looks. She also has learned to be honest and vulnerable, like she is being here, and talk about the things she is struggling with and how she has turned her failures into opportunities. For example, she wants people to know that even though her reveal videos look like perfection and she is so proud of the finished product, the work takes a lot out of her. She is very candid about how mentally and physically exhausted she is by the end of the weekend. Her last install took 3 days and she only slept about 2-2.5 hours each night. On the last night, after crawling up the stairs to her bedroom, she tried to shower and her feet hurt so badly from standing for nearly 72 hours straight that she laid down flat on the tile floor to wash her hair, physically on the ground. This exhaustion is why she doesn’t do reveals every weekend and only does one or two a month. The other weekends she uses to prep whichever five projects she has running simultaneously. 

She emphasizes, “I don’t regret the physical toll these weekend installs take on me. I love it all, but I want to make sure I’m not downplaying how difficult pulling this off is. Just because I’m doing something I am passionate about doesn’t mean it always jives with happy Taylor Swift lyrics. It is hard work, it is manual labor, it pushes me to my absolute physical and emotional limit. But if you do what you love, you push through because you know it’s worth it. Because it is.”

Ultimately, though her life is not at all what she expected, it is a different kind of fairy tale, you know, the kind where the princess saves herself from the tower.

She adds, “I just feel so fortunate, so grateful. This weekend surprise-design side hustle is so much more than a business. It’s the path that led me from being deathly insecure to discovering how to believe in myself and own my worth. It’s how I unleashed my passion so that I could unlock my purpose. To say I’m grateful for the pain I endured to get here is an understatement of epic proportion.”

Lyme disease is a tick-borne illness caused by the bacterium Borrelia burgdorferi and is the most common vector-borne disease in the United States

Each year, approximately 35,000 cases of Lyme Disease are reported to the CDC, which is about three times as many cases as were reported in the late 1990s. What’s even more worrisome is that these reports represent only a fraction of the total number of cases. Insurance data suggest as many as 476,000 people were diagnosed and treated for Lyme disease annually from 2010-2018, up more than 20% from around 329,000 cases per year during 2005-2010.

Why is Lyme disease increasing?

Scientists don’t know exactly why the incidence of Lyme disease is increasing. However, there are several contributing possibilities.

Tick expansion in time, number, and space

The black-legged tick (scientific name Ixodes scapularis, also known as the deer tick) is responsible for most cases of Lyme disease in the US, and seems to be increasing in abundance. The number of counties reporting the presence of  the black-legged species has more than doubled over the past twenty years. Black-legged ticks are also expanding in Canada, which has led to the introduction and expansion of Lyme disease there.

It’s not entirely clear why tick populations are expanding, but one explanation is the increase in the number of deer. Adult female ticks feed on deer and changing forest practices, including reforestation, resulted in an explosion of the deer population in the twentieth century, particularly in the Northeast where Lyme disease is most prevalent. As the food source for ticks has increased, so has the tick population.

Related, because tick development, survival, and activity are influenced by temperature and humidity, it’s quite possible that climate change has played a role. One study predicts that rising temperatures will boost the number of cases of Lyme disease by more than 20 percent by mid-century.

Exposure

Another contributing factor is the extent to which people come into contact with ticks. As Vox has reported, Duane Gubler, a former director of the CDC Division of Vector-Borne Infectious Diseases and world authority, believes that suburbanization, which is the population shift from urban areas to greener suburban neighborhoods, has caused people and ticks to come into contact more often than they used to.

Outdoor recreation has also been growing steadily, according to a technical report from the USDA National Center for Natural Resource Economics Research.

Awareness

Of course, another possibility is that there has simply been an increase in reporting. 

But there are several reasons to believe this doesn’t account for the pattern.

  1. One would expect an increase in reporting rate over time in areas where Lyme has only recently been detected. However, case reports are also increasing in places where the disease has been present for decades.
  2. Although there haven’t been serological surveys in people, which would assess the true extent of the disease regardless of case reporting, there have been surveys in dogs. These surveys confirm a general correlation between canine seroprevalence and human case reports. So, the trend is probably real.
  3. Finally, a survey of 6 million laboratory tests for Lyme disease shows an increase in test positivity (the fraction of tests that come back positive). If cases were going up just because of more intensive testing, then one would expect test positivity to go down.

As the weather warms up, people will spend more time outside. This should help to mitigate the Covid-19 pandemic, but it will increase opportunities for contact with ticks. Indeed, a recent study found that the ticks that transmit Lyme disease are as common around beaches as they are in the woods. It’s not that either beaches or woods need to be avoided. But protective measures like wearing long sleeves and pants and using insect repellent (which works, even though ticks aren’t insects) are a good idea.

Symptoms of Lyme disease include fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes, and many people develop a characteristic “bull’s-eye” rash at the site of the bite. See your doctor if you think you have been exposed. If caught in time, Lyme disease is readily treated with antibiotics.

Research has found that 53 percent of young American girls report having negative feelings about their bodies. By the time they reach the age of 17, that number grows to 78 percent. And boys are not immune to this negative self-talk. Approximately 30 percent of elementary school boys say they wish they could lose weight.

Raising a healthy child can be difficult enough. But raising a child who feels good about their healthy body can be a whole other challenge many parents don’t know how to conquer.

Prevalence of body image issues

“Body image struggles are common among teens as they correspond to rapid developmental changes in the body, more focus from oneself and others on those changes, and feelings of unfamiliarity with those changes,” explained Harvard-trained psychologist Sabrina Romanoff, PsyD. “This is only magnified in the digital world where curated and edited images of others make the unattainable or perfection seem like the norm.”

She said this can be dangerous for teenagers because they are often comparing their own bodies to unrealistic portrayals. They don’t realize that, though, and feel shame when they don’t think their bodies match up.  

Manifestation

Women’s health physiotherapist Melanie Stevens Sutherland, clinical director and senior physiotherapist of Body Co. Health, said that for girls, in particular, body image issues often result in a lack of confidence that can cause them to withdraw from activities and friends.

There is also a very strong association between a skewed or negative body image and a healthy relationship with food,” she explained. “By grade 4, most preteens report some

form of dieting specifically geared towards weight loss.”

Once a child starts grappling with how they feel about their body, Romanoff said those issues can manifest in a variety of ways.

“For some, there is motivation to emulate popular culture standards for what a body should look like or is desirable,” she said. “These kids will tend to sexualize themselves and present their bodies in more adult ways.”

She explained that the opposite can happen for other kids, where they resist changes to their bodies and the pressure to measure to up to beauty ideals.  

“These kids will wear baggy, childish, or loose fitting clothes to conceal and minimize attention to areas of their bodies they are insecure about,” Romanoff said.

When to be concerned

This isn’t just about kids feeling badly about themselves, though. Body image issues can evolve into more serious concerns.

“While we always want to be promoting body positivity, it becomes a concern when it starts to negatively impact behavior,” Sutherland said. “In 2018, The Canadian Paediatric Society found that teens who engage in unhealthy weight control (50% of girls and 30% of boys) are at risk for other health compromising decisions including smoking, substance abuse and unprotected sex, making it important to identify body image issues early on.”

She identified a few red flags that may indicate a problem parents should be aware of:

  • An extreme focus on food and exercise
  • A significant withdrawal from activities
  • Changes in interpersonal relationships

Romanoff added, “If your child is drastically modifying his or her eating habits, dressing inappropriately, is consumed with anxiety, depression or ruminative thoughts about appearance–these are indicators that intervention is needed.”

Helping kids develop a healthy body image

For all these reasons and more, it’s a good idea to head off body image issues whenever possible. That means raising kids to have a healthy relationship with their bodies from a young age.

“The single best thing parents can do is to model healthy relationships with their own bodies,” Romanoff said. “Children are incredibly impressionable and largely learn about the world from their primary caregivers. Be kind and forgiving to your own body, practice a healthy relationship with food, don’t be rigid or make harsh comments about your own body if your children are present or not.”

This may require some practice. And if you find it is too difficult to do, that may indicate a need to seek treatment yourself. Because as a parent, you really can help to prevent your child from developing similar issues.

Of course, there are also outside factors parents should be aware of.

“Social and traditional media have tremendous influence in this age group,” Sutherland said. “A 2010 survey of 1000 girls by the Girl Scouts found that 9 out of 10 girls felt pressure from the fashion and media industries to be skinny despite the fact that most imagery is not representative of healthy weights or realistic standards.”

Being aware of the content your kids consume, and helping them talk through that content with you, is one way you can better understand how they are processing it, while also helping them reshape their ideas about their own bodies in comparison to the ones they see on television and social media.

But removing them from social media isn’t the answer, according to Romanoff.

“It is a significant component of the culture and a tool for social bonding and connection with peers,” she explained. “Instead, educate them on the business behind the influencers they see on screen so they can approach social media more as informed consumers and less as blind followers.”

She further suggested parents help their kids to cultivate an identity beyond the screens and without focus on bodily appearance.

“Parents must model these activities themselves, such as reading, engaging in sports, and cooking. Show your children the power and potential of their bodies, beyond just appearance,” Romanoff said.

Helping kids who are already struggling

If you fear your child has already developed some body image issues, Romanoff said that getting some perspective from a third party can be a good idea.

“Kids may not be receptive to or willing to discuss these sensitive issues with their parents,” she explained. “A psychologist could be helpful to create a safe space to explore and unpack these issues.”

Sutherland added that this can be an important step at the first sign of developing body image issues, particularly because we know those issues have the power to evolve into other unhealthy behaviors.

“Find a practitioner who has a focus on teen health and who will work with the whole family as part of the comprehensive treatment plan,” she suggested.

Either way, the sooner you raise your own awareness about helping your child develop a health body image, the better.

“Children start to absorb messages around body image as early as six years old,” Sutherland said. “It is never too early to look inward or surround ourselves with communities that promote a body positive culture.”

For mankind to visit distant objects like Mars, scientists need to know what happens to the human body in space.

The microgravity environment created by flying through space causes a range of physiological problems. One problem is damage to the visual system, which can lead to a disease called ‘spaceflight-associated neuro-ocular syndrome‘ (SANS).

Until recently, the syndrome had only been studied in astronauts who had spent 4-6 months in space, with little known about long-term effects.

Research by NASA scientists has now shed light on how long-duration spaceflight changes structures in the human eye.

Led by Brandon Macias from the Cardiovascular and Vision Laboratory at NASA’s Johnson Space Center in Houston, Texas, the study involved observing two crew members in low-Earth orbit aboard the International Space Station (ISS) on a year-long mission.

The study included taking photos of the ocular structures in both astronauts before, during and after their time on the ISS. Those images were then used to measure things like thickness of the retina and length of the eyeball, as well as the length and depth of the anterior chamber (between the cornea and iris).

Measurements from the two men were compared against those from 11 crew members on six-month missions. The results showed no major changes in most structures, including eyeball length and chamber size, but there were a few differences.

After a year, both astronauts had developed swelling of the optic nerve, a bundle of neurons that relays visual information from the retina to the brain.

That swelling occurred at the disc-shaped head of the optic nerve, at the point just before the nerve leaves the eye (forming a blind spot on the retina). The swelling, known as an ‘optic disc edema’, got progressively worse over time.

One astronaut also developed folds in the choroid, the layer of blood vessels and connective tissue that lies between the retina — whose photoreceptor cells are sensitive to light — and the sclera, the white outer layer of the eyeball.

Structural changes to the choroid, like folding, can alter the overlying retina, which then disrupts the image of the outside world that’s detected by the eye’s photoreceptors — like a movie that’s distorted by a warped projector screen.

The study suggests that optic disc edema and choroidal folding contribute to spaceflight-associated neuro-ocular syndrome, whose symptoms include headaches and visual impairment such as far-sightedness (hyperopia), which causes near objects to appear blurred due to lower visual acuity at short range.

Understanding the syndrome is challenging because only about a dozen people go into space per year (roughly 3 every three months) so there are relatively few astronauts to observe, meaning a small sample size.

Given the damage revealed in the men who were in space for one year, the study recommends further observation of astronauts on long-duration missions, as the results will provide valuable insight on the impact of spaceflight on eyesight — knowledge that could be used to keep people healthy on manned missions.

According to NASA, a roundtrip mission to the Red Planet that would give future explorers time on the Martian surface would take about two years.

The Artemis program is aiming to put the next woman and man on the Moon by 2025 to establish a base for sustainable exploration so humans can reach Mars in the 2030s.