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The Wire
3 days ago
- Health
- The Wire
‘Surge' in COVID-19 Cases in India: What We Know and Don't Know About Newer Strains
Menu हिंदी తెలుగు اردو Home Politics Economy World Security Law Science Society Culture Editor's Pick Opinion Support independent journalism. Donate Now Top Stories 'Surge' in COVID-19 Cases in India: What We Know and Don't Know About Newer Strains Banjot Kaur 42 minutes ago Current data is inadequate to draw a complete picture. Hyperbolic news coverage also hides key scientific details of the situation. A medic at a ward prepared for COVID-19 patients at Gandhi Hospital in the wake of several states reporting Covid cases, in Hyderabad, Saturday, May 24, 2025. Photo: PTI. Real journalism holds power accountable Since 2015, The Wire has done just that. But we can continue only with your support. Contribute now New Delhi: The 'surge' in COVID-19 cases has been making headlines in India for about a week now. What should one make of the term 'surge'? Is the rise in the number of cases cause for alarm? The prevailing notion that 'COVID-19 is back' does not pass scientific muster because like any other virus, Sars-Cov-2 (causing COVID-19), never went away. Like all other viruses, it has been circulating all this time and will continue to do so. No virus has been eliminated in human history except smallpox. The periodic rise in cases is also likely to happen because Sars-Cov-2 is a fast-mutating virus. These are the 'surges' that are leading to a misinformed claim that 'COVID-19 is back'. Current 'surge' According to the data made available by the Union health ministry's online dashboard, there are 1,010 active cases in India as of May 25. The highest number of active cases are in Kerala (430) followed by Maharashtra (210), Delhi (104) and Gujarat (76). One of the metrics to understand the numbers is to look at the baseline which reflect the weekly change in the number of cases. Compared with week starting May 19, the highest change in the number of cases has been in Kerala (95 cases more cases this week) and Maharashtra (56 more cases this week), In such a situation, governments can make additional preparations and ask hospitals to remain at stand by as a standard protocol. Why this data is not the real picture The official data has several riders which are often missed in the current discourse and in panicked messages widely circulated on various social media platforms. The most important among them is the positivity rate, i.e, number of tests returning positive out of every 100 tests conducted. This is important to rule out any testing bias. Usually, when talk around COVID-19 cases going up gains momentum, a higher number of people get tested for the virus. The higher the number of people being tested, the greater are our chances of detecting more cases. This is the case because in the absence of such talk, fewer people get tested, and therefore, the number of people being tested positive is also small. Therefore, it is pertinent to know the positivity rate. The health ministry website has no updated information on the positivity rate of the current strains. The fact that Kerala has the highest number of positive cases can, therefore, also be a function of more tests being conducted there. Virus surveillance The Indian SARS-CoV-2 Genomics Consortium (INSACOG) is responsible for conducting genomic surveillance and finding out the current status of the strains circulating. Some of the tests that return positive are further analysed to understand the most commonly circulating strain. According to the INSACOG dashboard updated till May 26, JN.1 is the most common circulating strain. Some cases of a new strain NB.1.8.1 have also been reported but are not reflected in the dashboard. However, the number of sequences uploaded on the INSACOG dashboard has been extremely low, starting this year, thus seriously limiting the Indian genome sequencing capacity and its surveillance efforts. It is through genome sequencing alone that one can understand the scale of the dominant strain at a given point in time. In fact, only five centres out of 64 have uploaded the results of sequencing that started in January this year. Two medical colleges of Rajasthan and Gujarat, each, and the country's apex body, the National Institute of Virology, have done so. Therefore, less-than-adequate genome sequencing can also present a picture which is incomplete. Even the last INSACOG bulletin, issued on May 15, acknowledges this. 'Since the testing and the sampling frequency is less for some parts of India, the overall scenario might not be clear yet,' it says. Many countries do wastewater surveillance also to study the true prevalence of any strain as it reveals viral load or fragments of virus in sewage. In India, only a few entities do this in their own capacities. There is no centralised data available on this as the Union government has not taken up wastewater surveillance, even at the start and peak of the pandemic. WHO's classification of JN.1 and NB.1.8.1 The World Health Organisation (WHO) classifies new emerging strains under one of the three categories – variants under monitoring (VUM), variants of Interest (VoIs) and variants of Concern (VoCs). The least alarming are the ones classified as VuMs. If a strain is designated as VuM, it is a 'signal to health authorities that a new strain may require prioritised attention' over others. If a strain is classified as VoI, it indicates that it has the ability to spread faster than the previous cousins, cause a slightly more severe disease and 'suggests a potential emerging risk to global public health'. The strains classified as VoCs signal the highest degree of change. Such a strain may potentially overwhelm health systems across the world. A VoC can cause 'detrimental' change in disease severity, and cause significant immune evasion, that is, the circulating strain is successful in evading the immune system. Currently, the WHO has classified JN.1 as VoI. NB.1.8.1 has been characterised as VuM. All currently circulating strains are offshoots of the Omicron variant. Properties of NB.1.8.1 and JN.1 NB.1.8.1 has a greater ability than its previous cousins to bind to ACE2 receptors. The ACE2 receptors are present in cells of various body parts and they act as entry points for the COVID-19 virus into the body. The COVID-19 virus has what are known as 'spike proteins', or simply, spikes present on its outer surface. These spikes of the virus 'bind' with ACE2 receptors like lock and key to invade the body. Thus, the fact that NB.1.8.1 has a greater ability to bind with ACE2 receptors of the body indicates that it can easily gain entry into the body. This can increase the transmission potential of the virus – it can thus spread faster from one person to another. According to the latest WHO update, limited available evidence from different parts of the world indicates that this strain has led to an increase in hospitalisation numbers. However, these are early days for full evaluation of the NB.1.8.1. This is the case because the COVID-19 sequences global database, GISAID, has only 518 samples of this strain provided by 22 countries. This number is not enough to study its clinical outcomes in detail. 'The routine clinical surveillance data do not indicate any signs of increased severity associated with NB.1.8.1, compared to previously circulating strains,' says the WHO in its latest update. 'Currently there is no evidence of increases in indicators like COVID-19-related ICU admissions and deaths per hospitalisations, or all-cause mortality,' it adds. As far as JN.1 is concerned, which is currently the dominant strain in India, it has a growth advantage over previously circulating strains, as per the WHO. In other words, it can spread faster than other Omicron strains. However, the neutralisation capacity of the antibodies present in the immune system, i.e., their ability to neutralise or kill the virus is same for JN.1 as it is for other strains of the Omicron variant which had been circulating earlier. The WHO says the currently available evidence suggests that the additional health risk posed by JN.1 is low at the global level. The increase in hospitalisation numbers with JN.1 is unclear at the moment. There have been no reports of changes in disease severity with JN.1 as compared to other versions of the Omicron variant. According to this paper, JN.1 can cause fever, sore throat, excessive discharge of mucus from nose, nasal congestion, persistent dry cough, fatigue, headache, loss of taste, loss of smell, muscle pain, conjunctivitis, diarrhoea, and vomiting. 'Patients infected with the JN.1 strain may experience more severe muscle fatigue and exhaustion compared to typical COVID-19 cases,' it says. 'Mild symptoms can often be managed with symptomatic care and do not require immediate medical attention,' it adds. Patients who are immunocompromised – those whose immune systems are already compromised – due to certain illnesses are always at risk of developing a severe disease than others, be it any strain of the virus. Another risk associated with any variant of Sars-Cov-2 infection is Long COVID. While all the currently circulating strains are mostly known to cause a mild version of the disease, the risk of Long COVID is real and pertinent. WHO's technical lead on COVID-19, Maria Van Kerkhove, says, there is no substantial clarity as to how COVID-19 infections can impact our body in multiple ways even if one has got rid of the infection. 'Our concern is [that] in five years from now, 10 years from now, 20 years from now, what we are going to see in terms of cardiac impairment, of pulmonary impairment, of neurological impairment [caused due to long term impacts of new strains of the virus which would continue to emerge],' she says referring to Long COVID. § Although the fear of the 'unknowns' of this virus has subsided to a greater extent, not everything is known about the virus yet, as Kerkhove says. The best and the easiest way is, therefore, to take precautions which are not hard to follow. Vulnerable populations like elderly, people with comorbidities and compromised immune systems, especially need to take care. Insofar as the general population, following these precautions, like masking up in crowded places, can alway come handy to dodge the virus and its long term implications. Make a contribution to Independent Journalism Related News The Small Peak in COVID-19 Cases in South East Asia Is No Cause For Panic COVID-19 Led to Decline in Life Expectancy in India, Reveal Three Analyses The Many Failures of Operation Sindoor We Must Assess Sudden Deaths Which Took Place as a Consequence of COVID-19 Undercounting of COVID Deaths: Two Million More People Died in 2021 Compared to 2020, Shows Govt Data ECI Tried to Address the Duplicate EPIC Problem 4 Years Ago. Why Does it Persist? 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Hindustan Times
5 days ago
- Health
- Hindustan Times
Covid cases no cause for alarm, but stay vigilant, says ICMR DG
There is no need to hit the panic button just yet on the rising cases of Covid in the country, director general of Indian Council of Medical Research (ICMR) Dr Rajiv Bahl said, explaining that the sub-variant in circulation is a descendant of the Omicron variant that Indians are already exposed to. Speaking to HT in an interview, he, however, stressed that there is a need to be vigilant. Edited excerpts: Is there a surge in Covid-19 cases? There is a slight increase. Until March, there were almost zero cases of Sars-Cov-2, all the respiratory illness cases were either influenza A or B or RSV (Respiratory Syncytial Virus), and one or two cases of the human metapneumovirus. Since the end of April, we are seeing more cases of Sars-Cov-2. The virus is here, it's circulating. Where were the samples taken from? ICMR runs in 73 labs in medical colleges across the country. Samples are taken from both severe and non-severe patients of SARI (Severe Acute Respiratory Infection) and ILI (Influenza-like Illnesses). We test for all the six-seven common viruses in every patient; so, it is not that we have suddenly started testing for Covid. How serious does the situation seem? There is no need to be alarmed... Only isolated mild cases have been reported so far. But should we be complacent? The answer is no. Should we be vigilant? The answer is yes. Are the current variants more virulent? At this moment, there is no evidence that any one of the circulating variants causes more severe disease than the previous variants. There is an evolution of variants across the world… it is a sub-variant of omicron that we have seen — the BA.2.86 that has a sub-variant called JN.1. What are the variants in circulation? There is JN.1, LF.7, XFG and NB.1.8.1. However, all these have evolved from the Omicron variant BA.2.86 (also known as pirola) either in pure or recombinant form. None of them, however, have been shown to be more severe than what we already know about Covid-19. Do we have enough vaccines to deal with the current variants? We do not make vaccine for every variant… We do have the ability to make a vaccine against a variant but we don't need to make a vaccine. The need of the vaccine is to prevent severe disease and death; we have never given vaccines to prevent mild Covid cases. If severe cases and death are not happening in large numbers, then we don't need to give vaccine. We are seeing about 1,000 cases currently, if this number increases then we will consider what is the best vaccine to give.
Indian Express
17-05-2025
- Health
- Indian Express
Covid-19 surge in Hong Kong, Singapore: What's causing the spike?
Asian countries such as Singapore and Hong Kong have noted a surge in Covid-19 cases over the last few weeks. Health authorities in these countries have said that the increase may be because of waning population level immunity to the infection and fewer elderly getting their booster shots. 'There is no indication that the variants circulating locally are more transmissible or cause more severe disease compared to previously circulating variants,' said Singapore's ministry of health. What do the numbers say? Data from Singapore shows that the estimated number of Covid-19 cases in the week ending on May 3 went up to 14,200 from 11,100 a week before. The average daily hospitalisation due to Covid-19 during this period also increased from 102 to 133, but daily admissions to the ICU declined slightly from 3 to 2. The health authority added that LF.7 and NB.1.8 — both descendants of JN.1 variant that is used in new Covid-19 vaccines — were circulating in the country. These newer vaccines are unavailable in India. Hong Kong has seen an increase in Sars-CoV-2 viral load in sewage samples. It has also noted an increase in respiratory samples testing positive for Covid-19, increasing to 13.66 per cent in the week ending on May 10 as compared to 6.21 per cent four weeks ago. It has recorded 81 severe cases, with 30 deaths, almost all of which were in elderly people with underlying health conditions. Has Covid-19 become a seasonal infection? It is likely. Hong Kong's Centre for Health Protection (CHP) says, 'According to the surveillance data after the resumption of normalcy, there were two relatively active periods of COVID-19 in Hong Kong, which lasted for about 15 weeks from April to July 2023 and for about seven weeks from February to March last year. COVID-19 became more active in mid-April of this year (i.e. about four weeks ago).' Singapore's ministry of health says, 'As with other endemic respiratory diseases, periodic COVID-19 waves are expected throughout the year.' What about India? While not many are undergoing Covid-19 tests in India anymore, data collected from surveillance sites by ICMR laboratories show that there has been an increase in Covid-19 infections over the last few weeks — the number of Sars-Cov-2 positive samples increased to 41 during the week ending on May 11 as compared to 28 the week before, and 12 the week before that. However, the total number of respiratory infections has been on the decline since a surge in September last year. India typically witnesses two peaks of respiratory infections — one during the winter months and the second immediately after the monsoon. What should you do? There is no need to panic at the moment. However, if you do get a respiratory infection, stay at home so that you do not transmit it to others. Avoid closed or crowded spaces as much as possible. If you do have to step out, mask up. And, wash your hands as frequently as possible. These steps will keep you safe not just from Covid-19 but any other respiratory infection.
Yahoo
08-05-2025
- Health
- Yahoo
New study retraces Covid's origins to bats in southwest China or northern Laos
The virus that causes Covid-19 followed the same evolutionary path as Sars, a coronavirus that jumped from bats to wildlife to people in the early 2000s, according to an analysis of their genomes. In a paper published in Cell journal, scientists compared the genomes of 250 coronaviruses to reconstruct how the pathogens evolved over time, potentially offering insights into how Covid-19 spilled into people – an unresolved question that's been thrust back into the spotlight since Donald Trump assumed office. The researchers found that both Sars viruses were circulating and changing inside bats in southern China and neighbouring countries for hundreds of thousands of years before emerging in humans. Bats have unusual immune systems which allow them to harbour coronaviruses, allowing them to mix and mutate into something new. By unpicking this 'recombination' process, the scientists were able to estimate when and where each of the two coronaviruses had emerged in bats. They found Sars was circulating in western China just one to two years before it jumped into humans in Guangdong, central China. Sars-Cov-2 followed an 'extremely similar' route, they say. It made its final recombination between 2012 and 2014 in bats in southwest China or northern Laos, five to seven years before sparking a human pandemic Wuhan. The researchers say it is striking that, in both instances, the virus was circulating in bats hundreds of miles from where humans were first infected. In the case of Sars, there is strong evidence that wildlife sold in wet markets bridged this geographical gap and carried the virus to humans. Researchers have previously established that the virus was present in palm civets and other wild mammals for sale in markets at the time of the first Sars outbreak in 2002. They concluded that it was the wildlife trade which transported the pathogens hundreds of miles, from bat caves to people. Prof Michael Worobey, head of the department of ecology and evolutionary biology at the University of Arizona and a co-author of the paper, said that 'we're seeing exactly the same pattern with Sars-Cov-2'. Like Sars, Sars-Cov-2 evolved in bat caves hundreds of miles away from the spot humans were first infected. While the paper does not prove it was transported by the wildlife trade to the wet market around which the first human cases emerged in Wuhan, the authors said parallels between the two pandemics were too striking to be ignored. 'At the outset of the Covid-19 pandemic, there was a concern that the distance between Wuhan and the bat virus reservoir was too extreme for a zoonotic origin,' said Prof Joel Wertheim, a professor of medicine at UC San Diego School of Medicine's division of Infectious Diseases and Global Public Health. 'This paper shows that it isn't unusual and is, in fact, extremely similar to the emergence of Sars-Cov-1 in 2002,' he said. The question of how Covid-19 emerged has long been contentious, but tensions have ratcheted up since President Trump assumed his second term in office. Last month the White House created a website called 'Lab Leak: The True Origin of Covid 19', which suggests the pandemic was caused by human error in a Wuhan lab facility. Beijing then resurfaced its own conspiracy theory – believed by many in China – that the US's own high security labs were to blame. Prof Jonathan Ball, a professor of molecular virology at the Liverpool School of Tropical Medicine who was not involved in the paper, praised the new research for showing how the two Sars viruses had evolved. But he added that it could not settle the lab v natural origins debate. 'I sit in favour of the Huannan market [analysis], mainly because of all the other evidence. This paper adds another bit of evidence to that pile,' he said. 'But it's not going to quash the lab leak [hypothesis], and it won't persuade Donald [Trump].' Prof Stuart Neil, head of the department of Infectious Diseases at King's College London, also said the paper 'can't fill the gap between the bats and the market'. But he added that the evolution and geography of Sars and Sars-Cov-2 described in the paper clearly showed that both were able to fully emerge of their own accord in nature and that there was no reason it could not happen again. 'What [the paper] reinforces is that you need to control and monitor the most likely flash points for zoonotic emergence,' he said. Yet some remain sceptical of the idea that the wildlife trade carried the Sars-CoV-2 to Wuhan as happened with Sars in the 2002 outbreak. 'It's a very sophisticated analysis of the evolutionary origins of Sars viruses in their natural reservoir, however the analysis leaves two big gaps,' said Prof Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh. 'The story [for Covid] stops some years short of 2020, and it also leaves a very big gap in terms of space. 'I don't agree with the inference in the paper that the only plausible way that the virus could have gone from its natural habitat to Wuhan is through the wildlife trade. 'For me, there's no convincing evidence that the animals implicated in the early spread of Sars-Cov-2 [such as racoondogs] were farmed in the region where Sars-Cov-2 is thought to evolve. So for me, the most likely route that it got from one place to the other is via people,' Prof Woolhouse said. Protect yourself and your family by learning more about Global Health Security Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.
Yahoo
11-03-2025
- Health
- Yahoo
America is still grappling with uncomfortable pandemic truths
As we commemorate the fifth anniversary of theWorld Health Organization declaring the novel coronavirus a pandemic, this is the first of a six-part MSNBC Daily series that reflects on the million American lives lost, the political polarization and the declining trust in public health measures that followed the virus' spread and assesses the country's preparedness for the next pandemic. An oxygen concentrator being used by Lorena Martínez (not her real name) hums like a funeral dirge in her cramped Washington, D.C., apartment, its plastic tubing snaking across the carpet that her 13-year-old daughter vacuums between homework assignments and administering her mother's insulin injections. At 37, the former bakery manager survives as a living Venn diagram of America's pandemic failures. She was infected with Sars-Cov-2 (the Covid virus) in the summer of 2020 and had a complex hospitalization resulting in a kidney transplant and an inexplicable lung condition that has left her dependent on oxygen. Her story crystallizes the pandemic's cruel duality: Even as one part of America was questioning the efficacy of masks and social distancing, another part was fighting for breath in overwhelmed hospitals where doctors tried immunosuppressants, ventilation techniques, antivirals, antibiotics and anything else in the proverbial medical kitchen sink. The machines that kept Lorena alive testify to medicine's triumphs; the child shouldering this burden for an overlooked community exposes its bankruptcies. Five years later, we remain two nations: one that feels justified in minimizing Covid and rejecting any mitigation strategies and the other trapped in the long memory of infections, isolation and death. The evocative image of Covid that former President Joe Biden often cited, a family dinner table with an empty chair, is replicated in countless homes across the nation. Even so, a narrative of resilience and recovery often dominates the official discourse. The Covid-19 pandemic reveals itself not as a singular event but as a multifaceted crisis that exposed deep-seated fault lines in American society. The numbers tell a chilling tale: over 111.8 million confirmed cases and 1.2 million lives lost as of February 2025. Yet, these statistics, as vast as they are, fail to capture the pandemic's true scope: the silent suffering, the economic devastation and the erosion of social and scientific trust. From the outset, the pandemic cleaved the nation into two distinct camps. On one side stood those who embraced public health measures, sometimes at great personal and economic cost. This America witnessed firsthand the horrors of overwhelmed hospitals and clinics, where health care workers battled exhaustion and death daily or at least acknowledged and accepted as true reports of what was happening. The virus quickly surged past influenza, strokes, suicides and car crashes to become the third-leading cause of death in 2020 and 2021, behind only heart disease and cancer. This America, driven by a sense of collective responsibility, lined up for vaccines, wore masks religiously and curtailed social gatherings. On the other side, beliefs that reports about the virus were false or exaggerated and concerns over personal freedom and economic hardship fueled resistance to lockdowns, mask mandates and vaccination requirements. This America viewed public health restrictions as an infringement on individual liberties, questioning the severity of the virus and the motives behind government interventions. This group of Americans, taking their cues from social media and partisan news outlets, contributed to a climate of mistrust and division. The economic consequences of these divergent approaches have been profound. The U.S. gross domestic product contracted by 3.5% in 2020, a decrease not seen since the end of World War II. The pandemic's economic toll as of January 2023 was $4 trillion in government expenditures alone. The government's response to the crisis was unprecedented in scale. Operation Warp Speed assembled the best scientific minds to speedily and safely develop vaccines. The CARES Act, with its Economic Impact Payments, sought to provide a lifeline to struggling Americans. The Federal Reserve slashed interest rates and implemented liquidity facilities to stabilize financial markets. These measures came at a cost, with the national debt ballooning to levels unseen in peacetime and businesses large and small suffering from stay-at-home orders and distancing requirements. Perhaps the worst have been the effects on the children who missed graduations or attended most of their classes via computer screen and the adults whose deaths were marked only by virtual forms of grief. The most uncomfortable pandemic truths lie not in what we got wrong, but in what we refused to see in the evolution of a novel virus. Early missteps — from dismissing aerosol transmission risks to underestimating asymptomatic spread — weren't mere scientific growing pains; they were systemic failures of imagination that proved deadly for vulnerable populations. Our policy responses, though unprecedented in scale, became Rorschach tests for America's structural inequities. While white-collar workers Zoomed into virtual meetings, 72% of Black workers and 65% of Latino workers remained trapped in front-line jobs with Covid mortality rates 2.1 times higher than those of their white counterparts. The $5 trillion stimulus package that saved Wall Street failed to protect a variety of immigrant front-line workers (meatpackers, drivers, grocery store clerks) without relief checks or sick leave — the very essential workforce we applauded nightly from our doorsteps. Five years after the start of the pandemic, America's recovery remains fractured by policy choices and viral aftershocks. Unemployment rates have plummeted, but at least 3.6% of adults now battle long Covid— a medical limbo where 68% see no symptom relief after two years. The administration's reinstatement of 8,000 unvaccinated troops contrasts starkly with long Covid's $168 billion annual productivity drain. The unanswered questions loom largest: Could viral remnants awaken dormant diseases? Will long Covid's $3.7 trillion care burden eclipse initial deaths? The changes the Trump administration is implementing will hamper our ability to answer these questions. The Trump administration's 2025 executive orders have defunded 13 key health agencies, reducing budgets for pandemic preparedness while eliminating 5,200 public health positions, including 10% of the Centers for Disease Control and Prevention's outbreak and public health leadership. Where inadequate testing capacity once plagued communities, we now face active suppression: New Food and Drug Administration guidelines have halted emergency use authorization for Covid rapid tests, privileging 'natural immunity' narratives over diagnostic transparency. The supply chain vulnerabilities exposed in 2020 have become policy choices: The Department of Health and Human Services' travel restrictions now prevent epidemiologists from investigating H5N1 outbreaks unless mortality rates exceed 5%. As the MAHA Commission focuses on food additives and 'technological habit' reforms, the pandemic playbook that guided us through successive Covid waves gathers dust in agency archives. The lesson rings clear: America's public health vulnerabilities aren't merely systemic; increasingly, they're by design. Five years after the start of the pandemic, America stands fractured yet paradoxically transformed. The crisis magnified our deepest divides — urban versus rural, privilege versus poverty, individualism versus collective survival — while stress-testing democracy itself. Yet from this crucible emerged unexpected resilience: telehealth revolutions, remote work permanence and newfound reverence for grocery clerks and nurses. Now comes the existential task: weaving these fractured realities into a national tapestry that honors both our losses and our adaptations. The pressing question isn't whether we'll face another pandemic, but whether we can reconstruct a society in which Lorena's oxygen tubing and Wall Street's recovery packages occupy the same moral universe. The answer to this question will determine whether we can confront the H5N1 outbreaks now spreading through Midwest dairy farms, reverse plummeting childhood vaccination rates' fueling measles resurgences in 32 states and address climate-driven disease vectors creeping northward — all while navigating a political landscape in which pandemic-era fractures have metastasized into active hostility toward public health institutions. Our capacity to rebuild trust in science and bridge these divides may prove the ultimate test of whether Lorena's story becomes a relic of 2020s failures or a harbinger of a 2030s collapse. This article was originally published on
