A new COVID-19 subvariant, known as JN.1, has emerged and is now the prevailing strain across Canada, prompting health experts to caution that it may be more infectious and could even have extra symptoms.

Currently, the subvariant makes up the highest proportion of all COVID-19 variants, accounting for more than half (51. 9 per cent) of all infections in Canada, according to the latest data from the Public Health Agency of Canada (PHAC).

JN.1 was first detected in Canada on Oct. 9, and since then has rapidly increased.

If this virus continues to circulate at high levels, that means more virus, which means more mutations and more evolution, which means more of this same kind of issue happening repeatedly, warned Ryan Gregory, a professor of integrative biology at the University of Guelph, and evolutionary biologist.

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1:54 Low vaccine uptake fuels spike in respiratory illnesses: health officials

On Dec. 10, the JN.1 subvariant made up 26.6 per cent of all COVID-19 variants in Canada, but was not the dominant strain. At that time, HV.1 still made up 29 per cent of all subvariants, according to PHAC data. By Dec. 17, JN.1 made up the highest percentage (38.5 per cent) of all subvariants across Canada. Meanwhile, HV.1 fell to 24.4 per cent.

The World Health Organization (WHO) on Dec. 19 added JN.1 to its list of variants of interest, its second-highest level of monitoring. Despite the categorization, the health organization said JN.1 poses a low additional public health risk.

Two days later, on Dec. 21, PHAC labelled it as a variant of interest in Canada.

As the subvariant continues to circulate, here is what we know so far about JN.1.

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The JN.1 subvariant is a sublineage of BA.2.86 that emerged in Europe in late August 2023. It is another Omicron variant, according to PHAC. Gregory explained that JN.1 is a grandchild of BA.2.86. The original BA.2.86 probably evolved within a single person with a long-term infection over a year, he added.

So, somebody was infected. The virus continued to replicate and change within their body and then it reentered the rest of the population, he said. Once it gets back into the main population, its now evolving at the level of among hosts.

This in turn created the more competitive and successful JN.1. It featured a single alteration in the spike protein, enhancing its ability to effectively bind to cells, according to Gregory.

6:14 Holiday health update: Navigating the flu, RSV and COVID

It has massively managed to compete with the existing things that were out there, which suggests that its either very good at transmitting, and escapes immunity that is otherwise conferred by prior infection or previous vaccination, he said. So in other words, its different enough that your immune system, having been trained on older variants, doesnt recognize it as well.

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He also believes JN.1 may be the starting point for subsequent evolutions, much like the XBB variant. The XBB variant, another sublineage of Omicron, started circulating the world in late 2022. In 2023, some of its descendents, such as XBB.1.5 and EG.5, became dominating COVID-19 infections.

It is currently not known whether JN.1 infections produce different symptoms from other variants, health experts say.

The typical symptoms of COVID-19 according to the government are:

Additionally, Gerald Evans, an infectious disease specialist at Queens University in Kingston, Ont., said he has heard more people report gastrointestinal (GI) issues, such as diarrhea.

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The one thing I have been hearing about, they have GI symptoms, and these are not new, these have been recorded since COVID came out, he said. But anecdotally, the number of people having GI symptoms seems to be slightly higher, but you have to be careful with that because its an observational bias. But it does strike me that its becoming a bit more of a theme in the last month.

Gregory agreed with this observation but added that it may still be too early to tell if this is a hallmark symptom of the JN.1 variant.

He added that it is difficult to determine which symptoms go with what variant, especially when so many are circulating and there is less testing for COVID-19.

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Due to JN.1s fast growth, experts like Gregory say its either more transmissible or better at evading our immune systems. However, PHAC said in an email to Global News on Dec. 19, there is no evidence of increased severity associated with this variant.

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The WHO also stated last month that it is anticipated that this variant may cause an increase in COVID-19 cases amid a surge of infections of other viral and bacterial infections, especially in countries entering the winter season.

Since the spike protein is also the part that existing vaccines target, current vaccines should work against JN.1 and other lineages of BA.2.86, explained Evans. Preliminary evidence shows that protection by the XBB recombinant vaccine also guards against JN.1, he added. However, he cautioned, If it has been a year since your last vaccine or COVID infection, you may be more susceptible.

Personal protective measures are effective actions to help reduce the spread of COVID-19, PHAC stated. They include things like staying home when sick, properly wearing a well-fitted respirator or mask, improving indoor ventilation and practicing respiratory etiquette and hand hygiene.

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These measures are most effective when layered together, PHAC stated in an email.

Laboratory studies also suggest that the current therapeutic antiviral options, such as Paxlovid, available in Canada are expected to be effective against SARS-CoV-2 sub-lineages, PHAC added.

In some parts of the country, COVID-19 cases have been steadily increasing since the fall, yet the numbers appear to be stable now, according to Evans. However, while infection numbers remain stable, they are still very high and very steep, he warned, well beyond influenza, RSV and all the other viruses.

4:50 Kingston pharmacist urging residents to get vaccinated to avoid getting sick this winter season

He believes there may have been a holiday spike in COVID0-19 infections for several reasons, but most importantly noting that the uptake COVID-19 vaccine has been very poor.

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As of Dec. 8, PHAC reported that 14.6 per cent of eligible Canadians have received the updated vaccines targeting XBB.1.5.

The second reason, of course, is were in the middle of the respiratory virus season, Evans said. And although there are still a fair percentage of people who are being careful, there are a lot of people really have just gone back to what life was like before 2020. And. Thats, of course, a moment of opportunity for all these viruses to kind of take off.

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JN.1 is Canadas new dominant COVID-19 subvariant. Heres what to know - Global News

The findings of this comprehensive study demonstrate considerable evidence that there are associations between two polymorphisms of the CRP gene (rs1205 and rs1800947) with COVID-19 mortality.

CRP levels were statistically significantly higher in deceased patients than in recovered patients, as shown in this study. Several studies have found that CRP can be used as a biomarker for COVID-19 infection severity and mortality8,19. Angiotensin II converting enzyme (ACE2) can produce CRP when it interacts with SARSCoV220. The production of CRP by hepatocytes is stimulated by cytokines like interleukin6 (IL-6) and tumor necrosis factor- (TNF-) during COVID-19 development21. In one sense, CRP is responsible for activating the complement system, which contributes to inflammation. In contrast, severe COVID-19 patients will significantly damage their alveolar epithelial and endothelial barriers. The alveolar macrophages and epithelial cells are capable of producing a variety of cytokines and chemokines during an infection with SARS-CoV-2. In this phase, adaptive immunity is challenged by the significant decreases in lymphocytes and the T-cell-mediated immunosuppression. Therefore, in the context of COVID-19, uncontrolled SARS-CoV-2 infection could result in considerable macrophage infiltration, exacerbating acute lung damage22,23.

A number of SNPs are associated with plasma levels of CRP on the CRP gene. In addition to rs1205 and rs1800947 in the 3- and 5-flanking regions, rs1417938 is present in the intron, and rs1800947 appears in exon 224,25.

Currently, this is the first study to evaluate the relationship between CRP rs1205 and rs1800947 and COVID-19 mortality. COVID-19 death rates were significantly higher in patients with the CRP rs1205 T allele. In all patients, the MAF (T allele) was 0.42, which was lower in recovered patients (0.30) than in died patients (0.55). In other regions, the T allele was found in 0.597 Asians, 0.609 East Asians, 0.342 South Asians, 0.545 other Asians, 0.332 Europeans, 0.333 Latin Americans, and 0.201 Africans, as reported in the NCBI dbSNP database (https://www.ncbi.nlm.nih.gov/snp/rs1205).

Several studies have demonstrated that CRP levels are functionally influenced by the rs1205 SNP. CRP is a major component of the innate immune system, so this SNP may have an impact on SARS-Co-2 pathogenesis. A genome-wide association meta-analysis found that an intron variant (rs67579710) was associated with COVID-19 hospitalizations in 24,741 cases and 2,835,201 controls. Due to its location within the thrombospondin-3 gene, this variant may affect thrombosis related to COVID-19 rather than inflammatory pathways26,27.

According to the current study, all three variants of CRP rs1205 T allele were correlated with COVID-19 mortality. Several studies have found that CRP rs1205 affects both clinical outcomes and vaccination outcomes. It has been suggested that the frequency of rs1205 T allele was significantly higher in patients with community-acquired pneumonia compared with healthy controls, and T allele was associated with an increased risk of infection. Furthermore, the rs1205 CT and TT genotypes were substantially more common in patients with severe community-acquired pneumonia than those with non-severe community-acquired pneumonia18.

As shown in our study, numerous studies with different diseases have shown that the rs1205 T allele is associated with lower serum CRP levels18,28. Since the rs1205 TT genotype results in lower serum CRP levels and is associated with lymph node metastasis in this form of cancer, rs1205 may be associated with thoracic esophageal squamous cell cancer, myocardial infarction, systemic lupus erythematosus and lupus nephritis29,30. In studies with higher baseline CRP levels, pre-eclampsia risk is positively correlated with CRP genotypes. In contrast, as in the current study, CRP genotypes (including the rs1205 T allele) associated with lower CRP levels and have been correlated with greater infectious load. There may have been balanced selection on CRP polymorphisms during evolution because of these disparate effects18,31,32.

In this study, patients with the CRP rs1800947 G allele had a significantly higher death rate from COVID-19. In all patients, the MAF (G allele) was 0.47, with recovery patients having a lower value (0.40) than dying patients having a higher value (0.54). A study in Iran found that the frequency of G-allele was 0.45, which is similar to what we found in our study33. According to NCBI dbSNP database (https://www.ncbi.nlm.nih.gov/snp/rs1800947), Asians and East Asians were most likely to have the G allele 0.036, South Asians 0.000, other Asians 0.040, Europeans 0.056, Latin Americans 0.024, and Africans 0.010, respectively.

According to our results, the COVID-19 mortality rate was correlated with CRP rs1800947 GG genotype in all three variants, as well as with CRP rs1800947 CG genotype in the Alpha and Delta variants of the gene.

There is a strong association between the CRP rs1800947 and CRP expression and it has been shown to be associated with heart disease, diabetes, and cancer33,34,35. In contrast to the results of this study, previous reports have demonstrated that C-allele carriers have lower plasma levels of CRP than GG genotype. Clinical diagnosis and severity assessment of community-acquired pneumonia and COVID-19 are based on serum CRP levels19,36,37. The high mortality rate in deceased people infected with COVID-19 with GG genotype could be due to their higher serum CRP levels.

There is no correlation between the majority of SNPs and diseases or functional issues. In contrast, if SNPs are located on genes or regulatory regions such as promoters, enhancers, they may influence the function of genes involved in disease mechanisms36. CRP rs1800947 may have different effects. Since the rs1800947 SNP is silent, the mechanism behind expressed CRP levels could be linkage disequilibrium between the rs1800947 polymorphism and other functional SNPs both inside and outside the CRP gene. There is also the possibility that this polymorphism alters the kinetics of CRP translation, causing variable levels of CRP throughout the body38.

In this study, several limitations were observed that should be considered in future studies. Because there were no healthy controls in this study, the outcomes were not compared with healthy controls. This study should be confirmed with more research on other ethnic groups in Iran, since this country has a variety of ethnicities.

In conclusion, this study showed that COVID-19 mortality rate was correlated with CRP rs1205 TT genotypes and CRP rs1800947 GG genotypes across all three variants. In addition, higher CRP levels were observed in individuals with the CRP rs1205 CC genotype and the CRP rs1800947 GG genotype. To verify these findings, further research should be conducted in other regions.

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The death rate of COVID-19 infection in different SARS-CoV-2 variants was related to C-reactive protein gene ... - Nature.com

A drug promoted by former US President Donald Trump to cure COVID-19 has been linked to nearly 17,000 deaths, according to a new study. During the COVID pandemic, Trump urged Americans to take hydroxychloroquine (HCQ), an anti-malaria medicine that is also often used to cure rheumatoid arthritis and lupus, claiming that he himself had been taking the miracle drug.

After the outbreak of coronavirus, scientists suggested that HCQ could be effective in treating the deadly virus. On March 28, 2020, the Food and Drug Administration (FDA) approved the drug for an emergency use authorisation and started clinical trials.

While one scientist called the HCQ a "magic bullet" against coronavirus, Trump highlighted the "miracle" recovery made by a COVID infected woman after using the drug.

"The nice part is, it's been around for a long time...if things don't go as planned, it's not going to kill anybody," the ex-US president said during a COVID Taskforce briefing. In a tweet on March 21, 2020, he said that "FDA has moved mountains" and that the drug would be put to use "immediately" as an antidote to curb Covid transmission.

However in June 2020, the FDA revoked the emergency use authorisation of the drug as several studies, including one by New England Journal of Medicine, found HCQ had no benefit on COVID and led to significant surge in the risk of death. The FDA revoked the emergency use authorization on June 15, 2020.

A new study conducted by French researchers has found that nearly 17,000 people across six countries may have died after being prescribed hydroxychloroquine while hospitalized with the illness from March to July 2020 during the first wave of COVID. The research published in the February issue of Biomedicine & Pharmacotherapy shows that increase in the number of deaths was driven by side effects like heart arrhythmia and muscle weakness.

The countries studied were the US, Turkey, Belgium, France, Spain, and Italy.

The US reported the highest numbers of deaths with 12,739, followed by Spain (1,895 deaths), Italy (1,822 deaths), Belgium (240 deaths), France (199 deaths), and Turkey (95 deaths).

The scientists analysed various studies that tracked hospitalisations due to COVID-19 and exposure to the drug and risk related to it.

The researchers said that the number of deaths could be much higher as their study only looked at only six countries between March and July 2020.

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Donald Trump's 'miracle drug' for COVID killed nearly 17000 people, reveals new study - Hindustan Times

The holidays have come and gone, and once again Americans are riding a tide of respiratory ailments, including Covid. But so far, this winters Covid uptick seems less deadly than last years, and much less so than in 2022, when the Omicron surge ground the nation to a halt.

Were not seeing the signs that would make me think that were heading into another severe wave, said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. So far, were in relatively good shape.

Still, there are few masks in sight, and just a fraction of the most vulnerable people have received the latest Covid shots, she noted.

Its not too late, Dr. Rivers added. We have not even reached peak yet for Covid, and once you reach peak, you still have to get down the other side. That leaves plenty of time for the vaccine to provide some protection.

Federal officials are relying on limited data to measure this years spread. After the end of the public health emergency in May, the Centers for Disease Control and Prevention stopped tracking the number of Covid infections. The agency now has only partial access to information from states about vaccination rates.

But trends in wastewater data, positive tests, emergency department visits, hospitalization rates and deaths point to a rise in infections in all regions of the nation, according to the C.D.C. These patterns have prompted many hospitals to reinstate mask policies, after initially resisting a return to them this fall.

As in previous years, the numbers have steadily been rising all winter, and are expected to increase further after holiday travel and get-togethers.

Many of the infections are caused by a new variant, JN.1, which has rapidly spread across the world in recent weeks. I think that theres no doubt its helping drive, pretty substantially, this winter wave, said Katelyn Jetelina, a public health expert and author of a widely read newsletter, Your Local Epidemiologist.

Unfortunately, its coming at the same exact time as us opening up our social networks due to the holidays, she said, so theres kind of a perfect storm going on right now.

Some scientists have pointed to rising levels of the virus in sewage samples as an indicator that infections are at least as high this year as they were at this time last year. But Dr. Rivers urged caution in interpreting wastewater data as a proxy for infections and said hospitalizations were a more reliable metric.

In the week that ended on Dec. 23, hospitalizations rose by nearly 17 percent from the previous week. There were about 29,000 new hospital admissions, compared with 39,000 the same week last year and 61,000 in 2021.

And weekly hospitalizations are increasing more slowly than in previous years, Dr. Rivers said.

Covid is still claiming at least 1,200 lives per week. But that number is about one-third the toll this time last year and one-eighth that in 2021.

We are in this pretty big infection surge right now, but whats really interesting is how hugely hospitalizations have and continue to decouple from infections, Dr. Jetelina said.

She said she worried most about hospitals buckling under the weight of multiple epidemics at once. Even in years before the pandemic, outbreaks of just influenza and respiratory syncytial virus could strain hospitals; rising Covid rates now overlap both illnesses, adding to the burden.

The C.D.C. estimates that so far this season, there have been at least 7.1 million illnesses, 73,000 hospitalizations and 4,500 deaths from the flu.

While Covid tends to be mild in children and young adults, influenza and R.S.V. are most risky for young children and older adults. All three diseases are particularly dangerous for infants.

Emergency department visits for Covid are highest among infants and older adults. While R.S.V. has leveled off in some parts of the country, hospitalization rates remain high among young children and older adults.

The JN.1 variant accounts for nearly half of all Covid cases in the United States, nearly six times the prevalence just a month ago. The variant has one mutation that gives it a greater ability to sidestep immunity than its parent, BA.2.86, which was limited in its spread.

JN.1 may in fact be less transmissible than previous variants. But its immune evasiveness, coupled with the disappearance of preventive measures like masks, may explain its exponential growth worldwide, said Dr. Abraar Karan, an infectious disease physician and postdoctoral researcher at Stanford University.

Still, JN.1 does not appear to cause more severe illness than previous variants, and the current vaccines, tests and treatments work well against all of the current variants.

Experts urged all Americans including those not at high risk of severe illness to opt for vaccines against both Covid and flu, to use masks and air purifiers to prevent infections, to be tested and treated and to stay home if they become ill.

Even those who do not become severely sick run the risk of long-term complications with every new viral infection, researchers noted.

Im not at high risk, to be honest Im young and vaccinated, Dr. Rivers said. But I continue to take precautions in my own life because I do not want to deal with that disruption, and the risk that I could develop a longer-term illness.

But few Americans are following that advice. As of Dec. 23, only 19 percent of adults had received the latest Covid vaccine, and about 44 percent had opted for the annual flu shot. Just over 17 percent of adults aged 60 and older had received the vaccine for R.S.V.

Even among those 75 and older, who are at highest risk from Covid, only about one in three have received the latest shot, according to the C.D.C.

Many people dont realize that shots that protect against the newest variants are available, or that they should be vaccinated even if they are not at high risk, said Gigi Gronvall, a biosecurity expert at the Johns Hopkins Center for Health Security.

Even if the Covid vaccine does not prevent infection, it can shorten the duration and severity of illness, and minimize the risk of long-term symptoms, including brain fog, fatigue, movement problems and dizziness collectively known as long Covid.

Im sure also there are plenty of people who are actively hostile to the idea, but most of the people I encounter, they just dont even know about it, Dr. Gronvall said.

Poor availability of the shots, particularly for children and older adults, has also limited the vaccination rates.

Dr. Gronvall struggled to find a Covid vaccine for her teenage son. Dr. Jetelina has yet to find any for her young children. She said her grandparents, who are both in their mid-90s, also had an incredibly challenging time.

One of them is in a nursing home and still hasnt been immunized because she happened to be sick the one day the vaccines were offered.

Many nursing home residents and staff members remain unvaccinated, because the staff doesnt understand the benefits, said Dr. Karan, who worked with nursing facilities in Los Angeles County.

Financial incentives can improve vaccine coverage, but the lack of awareness about the benefits is a major problem, he said.

Experts also urged people who develop symptoms to take a test and ask for antiviral drugs Tamiflu for influenza, Paxlovid for Covid especially if they are at high risk of complications.

Paxlovid is still available free of charge to most people, but many patients and even doctors avoid it out of a mistaken belief that it causes Covid symptoms to rebound, experts said. Recent studies did not find a relationship between antiviral drugs and symptom rebound.

For many viruses, including the flu, we know that earlier use of antivirals is going to be beneficial, Dr. Karan said. You stop viral replication quickly, you have less of an immune dysregulation thereafter.

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Covid Has Resurged, but Scientists See a Diminished Threat - The New York Times

COVID cases are rising but hospitalizations and deaths are lower than last year's respiratory virus season. Patrick Sison/AP hide caption

COVID cases are rising but hospitalizations and deaths are lower than last year's respiratory virus season.

In most U.S. states, respiratory illness levels are currently "high" or "very high," according to data from the Centers for Disease Control and Prevention released Friday.

"After the holidays, after we've traveled and gathered, we are seeing what is pretty typical of this time of year, which is a lot of respiratory viruses," says Dr. Mandy Cohen, director of the CDC.

A few viruses have been driving the upward trend, including flu which is very high and respiratory syncytial virus or RSV which appears to have peaked around Thanksgiving.

COVID-19 levels have climbed higher than last season's peak. Still, they remain far below where they were at the height of the pandemic as do levels of severe disease.

"We are still very far below the levels that we were seeing with the omicron peak [in the 2021-2022 virus season]," says Amy Kirby, who leads the CDC's National Wastewater Surveillance System. "We're not looking at that really massive wave of infections. This is much more on par with what we saw [in the 2022-2023 season]."

And while COVID levels are still higher than they were last season, other COVID metrics including emergency room visits, hospitalization rates and deaths are lower now than previous seasons, indicating that "COVID-19 infections are causing severe disease less frequently than earlier in the pandemic," according to the CDC.

Respiratory viruses are hitting the southeast especially hard, said the CDC's Cohen, "but no part of the country is spared."

Flu levels are especially concerning. "The influenza virus is the thing that's really skyrocketing right now," says Dr. Steven Stack, public health commissioner for the state of Kentucky and president of the Association of State and Territorial Health Officials. "Influenza is sharply escalating and driving more hospitalizations."

The flu is coming in later this season, compared with the 2022-2023 season, when "RSV and flu really took off right at the same time along with COVID," says Marlene Wolfe, assistant professor of environmental health at Emory University and a program director at WastewaterScan. "All three of those together were pretty nasty. This year, there's more of an offset."

That has been good news so far for hospital capacity, which has remained stable this season, meaning that people who are quite ill and need medical care are generally able to get it.

Some hospitals in different parts of the country from Massachusetts to Illinois to California are starting to require masks for staff again and in some cases for patients and visitors.

Health officials say that getting the latest flu and COVID-19 vaccines now can still protect people this season. While Stack, with Kentucky's Department for Public Health, encourages seasonal preventive shots for everyone 6 months and older, he says it's particularly important for "everybody who is elderly and not even old elderly like young elderly, 60 and older," since they are more likely to get very sick from these viruses.

CDC data shows that fewer than half of U.S. adults have gotten a flu shot this fall and winter. That's still better than the vaccination rate for this season's COVID-19 booster, which fewer than 20% of U.S. adults have gotten, even though COVID-19 remains the bigger danger.

"The thing that is putting folks into the hospital and unfortunately taking their lives the virus that is still the most severe [at the moment] is the COVID virus," says the CDC's Cohen.

Beyond vaccines, health officials say there's still a place for masking as a preventive measure.

Those who are sick should stay home and watch their symptoms. If they progress beyond a runny nose and a light cough "to body aches, fevers, difficulty moving through your day, a heavier runny nose, a worsening cough ... [those more severe symptoms] should trigger you to go get tested," says Cohen.

Getting tested and diagnosed early, with COVID-19 or the flu, can help those at risk of serious illness get access to prescription pills that can reduce their chances of ending up in the hospital.

Flu and COVID-19 vaccines, tests and treatments should be covered by health insurance.

For those who are uninsured, the government is also offering a program called Test to Treat that offers free tests, free telehealth appointments and free treatments at home.

Cohen says people can protect themselves over the next few weeks by staying aware of what's happening in the community and their individual circumstances.

"You want to know what's happening in your community," she says. "Is there a lot of virus circulating? And then, what are the tools that I could layer on to protect myself, depending on who I am, my age, my risk, as well as who I'm around?"

The CDC has maps of COVID-19 hospitalizations down to the county level on its website, and it provides weekly updates on respiratory viruses nationwide. Cohen says there are many tools including vaccines, masks, rapid tests and treatments available to help people reduce their risks this season.

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COVID and flu cases are rising across the U.S. : Shots - Health News - NPR

In a surprising turn of events post-COVID-19, doctors are noticing a rise in cases of Avascular Necrosis (AVN), a condition causing the death of bone tissue, particularly in the hips. What's more surprising is that this is happening to a much younger crowd, people between 20 to 40 years old, whereas it used to be more common in people in their forties or fifties. If you have been treated for COVID-19 in the past and are now experiencing hip joint pain- early detection could help you! This is not only a red flag for old people but also younger demographic. Why is this occurring? Steroids were used even earlier for the treatment of conditions like asthma, arthritis, certain malignancies, and various other inflammatory conditions. It was an important risk factor for the development of AVN even then, albeit the incidence was lesser and the condition was much slower in disease progression. On the contrary, we are observing that patients who were affected with COVID and received steroid treatment, even for a short duration and with a lower dose are presenting with a much rapid destruction of the joint. This implies that its not just the steroid therapy but also the hypercoagulability and other vascular-related pathologies associated with COVID-19 that are contributing to the musculoskeletal damage. It is unpredictable as to which patient can develop this dreaded complication.

So what are the tell-tale signs to watch out for? It is predominantly pain in the hips, worsening on weight bearing and sometimes occurring even at rest. In the initial stages, it could be asymptomatic. Early detection, helps us identify this condition sooner and take measures to slow down the progression. AVN progresses through multiple stages and may not be detected on X-rays in the initial grade. It can be identified on the x-ray, usually in stage 2 or 3 when there is already a collapse of the femoral head (the ball in the hip joint). MRI is the only diagnostic tool that helps us pick up the disease in the initial stages of the pathology. When identified early, patients could benefit from joint preservation procedures like decompression surgery combined with stem cell therapy that can salvage the hip joint. Total hip replacement is recommended for those with collapse of the joint and irreversible damage as in stage 3.

Importance of Breathing Exercises

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How COVID and steroids are affecting the hips in young adults - IndiaTimes

Many people now view covid-19 as an almost routine inconvenience, much like flu, RSV and other seasonal infections. But four years after reports surfaced of a new respiratory illness, prompting a massive response among researchers, the diseases aftereffects commonly called long covid continue to confound doctors and patients alike.

We know a lot about this particular coronavirus, said Francesca Beaudoin, chair of the department of epidemiology at Brown University. That does not translate into an understanding of the long-term consequences of infection.

As many as 7 percent of Americans report having suffered from a slew of lingering symptoms after enduring covid-19, including fatigue, difficulty breathing, brain fog, joint pain and ongoing loss of taste and smell, according to the Centers for Disease Control and Prevention. But there is still no clearly defined cause of, or cure for the syndrome.

The costs of our lack of understanding are vast, Beaudoin and others say, creating a huge new burden on the health-care system, as people report limitations in their daily activities including being able to work.

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Four years on, long covid still confounds us. Here's what we now know. - The Washington Post

Some area Catholic churches have temporarily shelved their Holy Communion wine cups to help keep seasonal viruses at bay.

Citing an increase of various illnesses in our community, priests of the family of Catholic parishes in the Town of Tonawanda and cities of Tonawanda and North Tonawanda agreed this week to suspend distribution of wine in the chalice during Holy Communion.

The move was temporary and will be revisited as we get through this time of year when illnesses seem to rise, the priests said in a joint statement posted on Facebook.

We know many devoutly receive from the cup, but this is for the health of the community, the Facebook post noted.

The suspension applies to six parishes that make up Family #18: St. Amelia, St. Andrew Kim Mission and St. Christopher in the Town of Tonawanda; St. Francis of Assisi in the City of Tonawanda; and St. Jude the Apostle and Our Lady of Czestochowa in the City of North Tonawanda.

St. Gregory the Great is the biggest Catholic parish in the Buffalo Diocese, but the Rev. Leon Biernat says while many parishioners were enthusiastic about returning to the building worship, others were not due to worries about the coronavirus.

It had been brought up to me by a couple parishioners are we considering it? said the Rev. Michael Lamarca, pastor of the family of parishes.

Lamarca said he mentioned it Wednesday at a weekly meeting with fellow priests and it was unanimous right off the bat that weve all noticed more and more people getting sick.

Theres just so much out there, so we said, Lets just do it temporarily and well revisit it as we get through flu and Covid and RSV season, he added.

The Buffalo Diocese has not issued a directive and, so far, has left it up to pastors to decide. A diocese spokesman said officials were not aware of the communal wine chalice being removed for public health reasons at other parishes across the eight counties of the diocese.

Catholics believe bread and wine become the body and blood of Jesus Christ in the celebration of the Eucharist, and Holy Communion reception of the Eucharist is a central sacrament of the faith. The ritual dates back centuries.

Bishop Michael Fisher and three other bishops in the state this weekend lifted dispensations from obligatory Mass attendance that had been in place since the beginning of the Covid-19 pandemic.

The Body of Christ, in the form of an unleavened bread wafer, will continue to be offered at Communion in the Tonawanda parishes, and Catholic teaching promotes that receiving either the body or blood of Christ is as if receiving both.

Offering the Blood of Christ in the form of wine in a shared cup was halted during the Covid-19 pandemic. At the behest of bishops, the practice began returning to most parishes by fall 2022.

The rim of the communal chalice is wiped with a cloth after each recipient. It receives a wash in soapy water after the Mass.

Withholding the chalice during high respiratory virus season is a quite reasonable way to reduce some risk of disease transmission, said Dr. Thomas Russo, professor and chief of the Division of Infectious Diseases in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.

Respiratory viruses such as Covid-19, flu and RSV spread through respiratory droplets and secretions, and oral secretions potentially have infectious particles, he said.

Removing the chalice also can help limit exposure to norovirus, an extraordinarily infectious virus that causes vomiting and diarrhea and can peak in the winter, Russo said.

On the other hand, assuming the person handing out Holy Communion is not infected, receiving it in wafer form should present little risk, he said.

The bigger concern is crowded churches with poor ventilation, said Russo, who recommended that people with high-risk conditions wear masks to cut down on exposure to airborne viruses.

This applies not just to church, he said, but any venue thats indoors, particularly if the ventilation is poor, if its crowded and other people arent wearing masks and youre high-risk. That would be a setting where you would want to wear a mask to protect yourself. Masking isnt perfect, but its not bad. Its better than no mask.

Lamarca said he wasnt sure exactly when the shared cup would return.

We didnt want to put a timeline on it, he said, because we wanted to see how things play out.

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Catholic parishes in Tonawandas put wine chalice on shelf to ward off flu, Covid, other viruses - Buffalo News

COVID cases are increasing globally. India recorded more than 4,400 COVID cases as on Friday. Cases of COVID have been increasing in the country ever since the first case of JN.1 variant was detected in Kerala. The JN.1 variant, an offshoot of the BA.2.86 variant is currently responsible for more than 60% of COVID cases in the US. In view of the emerging variants of the COVID-causing coronavirus, it is essential to know about the effects of the virus on the human body. A new study has shed light on the effect of COVID on the cognitive function of the brain. The study, not peer-reviewed yet, found a substantial increase in the likelihood of being diagnosed with a schizophrenia spectrum and psychotic disorder (SSPD) after experiencing moderate to severe illness due to SARS-CoV-2 infection, in comparison to a group of individuals who had non-Covid Acute Respiratory Distress Syndrome (ARDS). Our study is consistent with the known neurotropism of the SARS-CoV-2 virus and other reports of increased risk of major psychiatric disorders following Covid-19 infection, said Asif Rahman, from the Department of Industrial & Management Systems Engineering, West Virginia University. Further research is required to identify specific characteristics of populations and individuals who may be at a particularly high risk of developing SSPD and potentially other significant psychiatric conditions following Covid-19 infection. Understanding these psychiatric risks associated with Covid-19 is an essential component of our strategy to address the evolving landscape of long-Covid, added Rahman, in the paper posted on a preprint site. Schizophrenia is a severe mental disorder characterized by distorted thinking, disrupted emotions, and abnormal perceptions of reality. It typically manifests in early adulthood, impacting a person's ability to function in daily life. Common symptoms include hallucinations (false sensory perceptions), delusions (false beliefs resistant to reason), disorganized thinking, and impaired social or occupational functioning. Long-term high fat diets linked to increased risk of COVID, finds study The exact cause of schizophrenia is unclear, but a combination of genetic, environmental, and neurobiological factors likely contribute. Genetic predisposition, neurotransmitter imbalances (particularly involving dopamine), and structural brain abnormalities are implicated. Subtypes of schizophrenia exist, with paranoid, disorganized, catatonic, residual, and undifferentiated forms identified. Treatment often involves antipsychotic medications to manage symptoms, therapy to enhance coping skills and social functioning, and support from mental health professionals, family, and friends. While medication can help control symptoms, the course of schizophrenia varies, and individuals may experience periods of remission and relapse. Early intervention and ongoing support are crucial for managing the condition. Stigma surrounding schizophrenia persists, highlighting the importance of education and understanding to promote empathy and effective mental health care.

How did the researchers find this correlation? Different from other studies, the team took acute respiratory distress syndrome (ARDS) and COVID lab negative cohorts as control groups to accurately gauge the impact of COVID on SSPD. Data from 19,344,698 patients were methodically filtered to create propensity-matched cohorts: ARDS, Covid-positive, and Covid-negative. They analyzed the hazard rate of new-onset SSPD across three distinct time intervals: 0-21 days, 22-90 days, and beyond 90 days post-infection. COVID positive patients consistently exhibited a heightened hazard ratio across all intervals, the findings showed. These are notably higher than both ARDS and Covid-19 lab-negative patients, the team said. Intriguingly, our data indicated that younger individuals face a heightened risk of SSPD after contracting Covid-19, a trend not observed in the ARDS and Covid-negative groups, they added.

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COVID increases risk of schizophrenia? Read what a new study has found - IndiaTimes

Lincoln hospitals are seeing more patients amid a spike in respiratory illnesses, and at least one is bringing back masks for certain staff members.

According to the Lincoln-Lancaster County Health Department, the county recorded 342 COVID-19 cases the week before Christmas, the highest weekly number of cases since the same week in 2022. The Health Department also reported 2023 highs for weekly positive influenza and respiratory syncytial virus during the same week.

Levels of COVID-19 in wastewater, which health experts say is a better gauge of virus levels in the community, also surged the week before Christmas. Health Department sampling showed an average of 1.5 million virus particles per liter of wastewater, up from about 910,000 the previous week. That's the highest weekly measurement in nearly two years.

Case numbers for all three illnesses dropped last week, but experts say that's likely more due to people being unable to access health care on certain days during the holiday break than an actual decline in cases.

"Respiratory illness is on the rise in the community and that's concerning," said Health Director Pat Lopez.

The surge in virus cases has led to increased activity at Lincoln's two hospital systems.

The Centers for Disease Control and Prevention reported 39 hospital admissions in Lincoln for COVID-19 the week ending Dec. 23, a 15% increase from the previous week.

CHI Health Saint Elizabeth in Lincoln has seen an uptick in visits to its emergency department by people with flu-like symptoms over the past six to eight weeks, said CHI Health spokesperson Taylor Miller.

"Our inpatient admissions went up after Thanksgiving and have remained steady, but we expect that admissions may increase again following Christmas and New Year's," said Miller, who noted the hospital saw a large increase in people testing positive for respiratory illnesses this past weekend.

Bryan Health also has seen increasing numbers of inpatients with respiratory illnesses.

Spokesperson Edgar Bumanis said Bryan had 34 COVID-19 patients for the week that ended on Saturday, up from 31 the week before. The hospital system also had three hospitalized flu patients and five with RSV.

Because of the prevalence of the flu, Bryan is now requiring staff members who have not gotten a flu shot to wear a mask at work, Bumanis said. He also said certain departments are instituting mask policies when levels of respiratory illnesses among patients reach a "problematic level."

"For example, currently pediatrics and our Independence Center have staff wearing masks, as well as staff working with immunocompromised patients," he said earlier this week.

Respiratory viruses aren't just an issue in Lincoln. Data from the Nebraska Department of Health and Human Services shows a rise in COVID-19, flu and RSV cases right up until Christmas, although the increase was less pronounced than it was locally.

COVID and RSV cases declined last week, but the number of flu cases continued to increase.

Compared with the same time last year, levels of COVID-19 cases are slightly lower statewide and flu case numbers are about the same, but RSV cases are significantly higher.

Lopez said she expects that the current spike in illnesses will last at least a few more weeks, especially with the holidays having just ended and local children set to return to school on Monday.

She said one thing that can help mitigate illness spread is for people to get COVID-19 and flu vaccinations if they haven't already and for those eligible for RSV vaccinations people 60 and over and women who are 32-36 weeks pregnant to get them as well.

Also, Lopez offered some commonsense advice: "Stay home if you are sick."

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Staff use personal protective equipment in the COVID-19 unit at Bryan Health.

Bryan has made counseling services available to its employees who work in the units hit hardest by the pandemic and has offered to rotate staff who need a week respite on another floor."That gives them just enough of a break to come back and say 'I can do this for another four weeks,'" said Candy Locke, the nurse manager.

The people who work in the COVID-19 ICU that currently takes up a large part of the sixth floor at Bryan East Campus say they are worn out."When the nurses are having nightmares at night and they're telling you about it, it's rough," said Leah Harrington, an assistant nurse manager.

A staff member in personal protective equipment tends to a patient in the COVID-19 unit at Bryan Health. COURTESY PHOTO

For months, doctors, nurses and respiratory therapists have worked to help COVID-19 patients on 6N, the ICU unit at Bryan East Campus. In many cases, patients who are breathing on their own see their conditions quickly worsen."It's hard to go home and not think about that, to just kind of de-plug from work, because these patients are so scared, and we're trying everything," nurse Kelsey Hoppe said.

Staff talk outside a patient's room on 6N, the ICU unit for COVID-19 patients at Bryan East Campus last September.

Reach the writer at 402-473-2647 or molberding@journalstar.com.

On Twitter @LincolnBizBuzz.

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COVID, other respiratory illnesses surging in Lincoln - Lincoln Journal Star

A heavily mutated, fast-spreading new COVID-19 variant called JN.1 is on the rise in the United States. Last month, JN.1 swept the country and quickly overtook other variants of the coronavirus to become the dominant strain nationwide.

The highly contagious omicron subvariant now accounts for over 60% of all infections in the U.S., and it's expected to continue driving an increasing number of cases as the country approaches peak respiratory virus season. In fact, data show and some experts say the country is currently in its second-largest COVID wave, smaller than only the omicron surge in late 2021 and early 2022.

JN.1 is also gaining speed in other parts of the world. On Dec. 18, the World Health Organization classified JN.1 as a variant of interest due to its rapidly increasing spread globally.

In the U.S., the share of cases caused by the JN.1 variant has nearly doubled in recent weeks. JN.1 is currently considered the fastest-growing variant in the country, according to the U.S. Centers for Disease Control and Prevention.

During a two-week period ending on Dec. 23, JN.1 accounted for about 44% of cases in the U.S., per the CDCs latest data. This was a steep increase from the previous two-week period ending on Dec. 9, when JN.1 made up 21% of cases.

After JN.1, the next most common strain in the U.S. right now is the HV.1 subvariant, which comprised about 22% of cases as of Dec. 23.

Scientists around the world have been closely monitoring JN.1, which has sparked some concern due to its rapid growth and large number of mutations. However, the new variant is closely related to a strain we've seen before: BA.2.86, aka "Pirola," which has been spreading in the U.S. since the summer.

JN.1 has one additional mutation compared to BA.2.86, which has more than 30 mutations that set it apart from the omicron XBB.1.5 variant. XBB.1.5 was the dominant strain for most of 2023 and it's the variant targeted in the updated COVID-19 vaccines, TODAY.com previously reported.

All of the COVID-19 variants that have gained dominance in the U.S. in the last year are descendants of omicron, which began circulating in late 2021. Since emerging, JN.1 has overtaken its parental strain BA.2.86, as well as HV.1, EG.5 or Eris and XBB.1.16, aka Arcturus.

JN.1's growth comes as COVID hospitalizations rise, influenza continues to spread and RSV activity remains high in many places, according to a Dec. 14 update from the CDC. The agency warned that at the end of the month, emergency rooms and hospitals could become strained, similarly to last year, especially in the South.

Will JN.1 cause a COVID-19 surge? Does JN.1 have different symptoms and is it still detected by COVID tests? Does it respond to vaccines and treatments? Here's what experts know about JN.1 so far.

JN.1 was first reported in August 2023 and it has spread to at least 41 countries so far, according to the WHO. It was first detected in the U.S. in September, the CDC said.

Just like the other newer variants, JN.1 is part of the omicron family.

"Think of (the variants) as children and grandchildren of omicron. They're part of the same extended family, but they each have their own distinctive personalities," Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, tells TODAY.com.

JN.1 descended from BA.2.86, which is a sublineage of the omicron BA.2 variant, TODAY.com previously reported that's what sets JN.1 and BA.2.86 apart from the other prevailing variants like HV.1 and EG.5, which descended from omicron XBB.

When its parent BA.2.86 emerged, everybody was worried because it had a lot of mutations and looked like it was going to evade a lot of the immunity from vaccines and infection in the population, Andrew Pekosz, Ph.D., professor and vice chair in the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, tells TODAY.com. But (BA.2.86) sort of fizzled out, he adds.

Laboratory data suggest that Pirola is less contagious and immune-evasive than scientists once feared, NBC News reported.

JN.1, however, picked up an additional mutation in its spike protein called L455S, says Pekosz. Spike proteins help the virus latch onto human cells and play a crucial role in helping SARS-CoV-2 infect people, per the CDC. This mutation may affect JN.1's immune escape properties, says Pekosz.

"Now it's circulating and growing at a really fast rate compared to other variants, as well as the parent its derived from (BA.2.86), says Pekosz.

In early November, JN.1 accounted for fewer than 1% of COVID-19 cases in the U.S. Several weeks later, it was driving over 20% of cases, Dr. Michael Phillips, chief epidemiologist at NYU Langone Health, tells TODAY.com. Now, it's the dominant strain in the U.S.

Its not known whether JN.1 causes different symptoms from other variants, according the CDC.

Right now, theres nothing that says that JN.1 infection is any different from previous COVID variants in terms of disease severity or symptoms, but were paying close attention, says Pekosz.

The symptoms of JN.1 appear to be similar to those caused by other strains, which include:

According to the CDC, the type and severity of symptoms a person experiences usually depends more on a persons underlying health and immunity rather than the variant which caused infection.

While severe infections do still occur, overall (COVID-19) is causing a lot of milder illness, says Schaffner.

Some doctors have reported that upper respiratory symptoms seem to follow a pattern of starting with a sore throat, followed by congestion and a cough, NBC News previously reported.

The virus is adapting. ... I think its getting better at infecting humans and evading pre-existing immunity in the population ... but its not changing symptomology too much, says Pekosz.

At this time, theres no evidence that JN.1 causes more severe infection, the experts note.

One of the things these (omicron variants) have in common is that they are highly contagious, and as new variants crop up, they seem to be as contagious or even more contagious than the previous variants, says Schaffner.

According to the CDC, the continued growth of JN.1 suggests that the variant is either more transmissible or better at evading our immune systems.

Its probably a little bit more transmissible than its parental virus because weve seen an increase in case numbers that we didnt with (BA.2.86), says Pekosz. However, it is too early to tell how exactly JN.1's transmissibility or immune escape properties compare to other variants, such as HV.1, the experts note.

Many of the newer strains, including JN.1, have another mutation that affects how strongly the spike protein binds to cells in the respiratory tract, says Pekosz. We know that its probably helping the virus become better at replicating and helping the virus evade more of that pre-existing immune response, he adds.

JN.1 does not pose an increased public health risk compared to other variants currently in circulation, the CDC and WHO said.

The genetic changes in JN.1 could give it an advantage over other variants, but its unclear how that will affect cases in the coming months. So far, there doesnt seem to be a massive increase in transmission. ... We would be concerned if there was a huge surge in cases, says Pekosz.

Right now, JN.1 is increasing in terms of the percentage of COVID-19 cases its causing, and theres also been a slight increase in total cases," says Pekosz.

Test positivity, an early indicator of case levels, is also on the rise, says Phillips the rate was 12.7% during the week ending on Dec. 23, up from about 12% the week prior, per the CDC. (The CDC no longer tracks the total number of cases in the U.S.).

Hospitalizations have also risen by 17% and ICU admissions by 16.4% in the last two weeks, according to an NBC News analysis.

"The good news is that as of yet we're not seeing severe disease or hospitalizations going up significantly, and ICU admissions are still very low, but we're going to watch these carefully," says Phillips.

COVID-19 activity was expected to rise around this time as the U.S. enters winter and respiratory virus season, the experts note. In recent years, the virus has followed a pattern of increasing and peaking around new year, according to the CDC.

"Right now, we do not know to what extent JN.1 may be contributing to these increases or possible increases through the rest of December," the CDC said. Only time will tell whether JN.1 or another variant will cause a surge in infections this winter.

All COVID-19 diagnostic tests including rapid antigen tests and PCR tests are expected to be effective at detecting JN.1, as well as other variants, according to the CDC.

Testing is an important tool to protect yourself and others from COVID-19, especially ahead of indoor gatherings, says Schaffner.

The symptoms of COVID-19 are often indistinguishable from those caused by other viruses spreading right now, the experts note. These include respiratory syncytial virus (RSV), influenza and rhinovirus, which causes the common cold.

The experts urge anyone who becomes ill or is exposed to COVID-19 to take a test, especially people at higher risk of severe disease, such as people over the age of 65, who are immunocompromised and who have underlying health conditions.

Every American can order four free at-home COVID-19 tests from the government, which will be delivered by mail via the U.S. Postal Service. To order your free tests, go to COVIDTests.gov.

"Get tested because, whether it's COVID or flu, we have treatment available," says Schaffner. Current treatments are also expected to be effective against JN.1, the CDC said.

"JN.1 should be just as sensitive to the antivirals available as any other variants," says Pekosz, adding that antivirals like Paxlovid are most effective when taken within the first few days after infection.

The new, updated COVID-19 vaccines, recommended for everyone 6 months and older, are expected to increase protection against JN.1, as well as other variants, the CDC said.

Although the shots target omicron XBB.1.5, which has since been overtaken by HV.1, JN.1, EG.5 and others, there is still evidence that it will protect against new strains circulating this winter, TODAY.com previously reported.

Data from laboratory studies show that the vaccine appears to generate a strong immune response against JN.1's parent strain, BA.2.86, Schaffner notes.

The new vaccines also protect against severe disease, hospitalization and death, the experts emphasize. So even if you get COVID-19 after vaccination, the infection will likely be milder and it can keep you out of the hospital, Phillips adds.

However, uptake of the updated booster among the U.S. population has been low so far, the experts say. As of Dec. 22, only about 18% of adults and 7% of children have gotten the updated vaccine, according to the latest CDC data on vaccination trends.

On Dec. 14, CDC officials issued an alert to warn about low vaccination rates against COVID-19, flu and RSV in the U.S.

Now is the best time to get vaccinated if you haven't already, the experts say. "The sooner you get vaccinated, the sooner you'll be protected and it does take seven to 10 days for protection to build up to the maximum," says Schaffner.

Phillips recommends everyone, especially high-risk individuals, to get the seasonal influenza shot, as well. Hospitalizations for flu increased 200% over the past month, according to the CDC's Dec. 14 warning.

"Getting vaccinated is the best present you can give yourself and your family this holiday season," Schaffner adds.

Every day, but especially during respiratory virus season, people can take steps to protect themselves and others from COVID-19.

The experts encourage everyone to:

Stay up to date with COVID-19 vaccines.

Test if you have symptoms.

Isolate if you have COVID-19.

Avoid contact with sick people.

Improve ventilation.

Wear a mask in crowded, indoor spaces.

Wash your hands with soap and water.

This article was originally published on TODAY.com

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A new COVID variant is dominant in the US: Know these symptoms - Yahoo News

READING, Pa. - Respiratory illness numbers are going up across the country following holiday gatherings.

According to the Centers for Disease Control and Prevention, as of this past week, flu activity is high in Pennsylvania, and very high in New Jersey.

In our very own region, "We are seeing more cases of respiratory illnesses." says Dr. Debra Powell, chief of infectious diseases at Tower Health, "Be aware that most of our hospitals are close to capacity a number of days we have been over capacity and have had to open up additional beds for patients."

Many of those beds are filled with patients needing care for Covid, RSV and the flu. "We are primarily seeing the high-risk age groups which are those people of older ages and also people with chronic medical conditions like diabetes, lung diseases, heart diseases." says Dr. Powell.

Dr. Debra Powell of Tower Health says the rise in cases is expected. "I think we're seeing about the same number we saw this time last year maybe about an extra 10 patients." says Dr. Powell, well below numbers from 2 or 3 years ago, but she still urges people to do their best to avoid getting sick.

"Be up to date on your vaccine, if you're sick please stay home, call your primary care physician if you need additional testing or treatment." says Dr. Powell.

Dr. Powell recommends getting the new omicron covid vaccine released in September as well as your flu shot.

The good news is, "What we're seeing with RSV is those numbers have come down it has plateaued." says Dr. Powell.

How long will the spike last? "We will see flu probably till after the spring hopefully it'll peak and then start to tamper down." says Dr. Powell, "We don't know what happens with covid, it depends on the strains that are circulating."

Her prediction is that it'll peak by mid-January and go down, but time will tell the doctor says.

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COVID, RSV and Flu cases on the rise in Berks County - 69News WFMZ-TV

An appliance market in Xi'an, China, where Jiang has a construction equipment rental company. He says economic conditions are worse now than during the pandemic, when he started the appliance business, and he isn't selling as much as he used to. John Ruwitch/NPR hide caption

An appliance market in Xi'an, China, where Jiang has a construction equipment rental company. He says economic conditions are worse now than during the pandemic, when he started the appliance business, and he isn't selling as much as he used to.

BEIJING On the northern edge of Xi'an, a 45-year-old man surnamed Jiang tells a typical story of dream-chasing in China's reform era.

He left his home village at the age of 18 to work in a diamond factory in southern China's Guangdong province, a manufacturing juggernaut. The pay was decent, he says, but after a decade he was restless. So he returned home, where he started a small construction equipment rental company.

Business was fine, he said, until state-backed competitors began attracting all the contracts. So he moved again, this time to the northwestern city of Xi'an, China's onetime imperial capital, now home to 13 million people.

"My hopes were big," he says, sitting in the back of the secondhand kitchen appliance shop that he runs with his family, surrounded by refrigerators, stoves and blenders. "Slowly, though, they have been obliterated."

A year ago, China lifted draconian COVID restrictions that were an anvil around the neck of the economy and placed unprecedented controls on a society that, for the previous four decades, had grown accustomed to expanding personal freedoms, not shrinking them.

Many expected the country to bounce back quickly, with economic growth reverting to a slower but respectable mean. That hasn't happened. And as 2024 approaches, there is a crisis of confidence in China that the authorities appear to be doing little to address, instead nibbling at the edges of policy and avoiding bold steps to revive the economy and regain public trust in policymaking.

Jiang is one of several people NPR recently spoke with to try to gauge the mood in post-pandemic China and highlight how things have changed over time.

For Jiang, who did not want his full name used for fear of possible repercussions for speaking candidly to a foreign reporter, economic conditions are actually worse now than during the pandemic, when he started the appliance business, he says. He isn't selling as much as he used to.

Like many in China who have been conditioned to avoid publicly criticizing the ruling Communist Party, he chooses well-worn rhetoric absolving the leadership when asked if he thinks policy might be to blame.

"Whatever the national policy, it's meant to do good for the country and the people. You can't deny that," he said. "But as they say: The higher-ups have their policies and the lower-downs have their ways of getting around them. ... Each policy that comes from the top is discounted on the way down, and then discounted again as it goes down line. The policies are definitely good, but when they get down to the local level, they've completely changed."

At this point, Jiang's ambition the same drive that, multiplied across hundreds of millions of people, fueled China's economic rise has been sapped.

In Beijing, Joerg Wuttke has had a front-row seat to China's spectacular rise. He first came to the country as a businessman from Europe 41 years ago.

"When I was coming in '82, people took pictures with cars and paid for the picture. And now we have 5 million cars in Beijing. So it's a completely different country, with upsides but also with it downsides," he said. (The Beijing government said that at the end of 2022 there were, in fact, more than 7 million motor vehicles registered in the city, and over 12 million drivers.)

Joerg Wuttke, then the European Chamber of Commerce president, at a press conference in Beijing in 2015. Ng Han Guan/AP hide caption

Joerg Wuttke, then the European Chamber of Commerce president, at a press conference in Beijing in 2015.

I first met Wuttke a little over 20 years ago, when our offices were in the same building near Beijing's Liangma River. China had just joined the World Trade Organization. The reform-minded Zhu Rongji was premier.

"It was a China which actually was very open and could sort of give us some indications of where we're heading, you know, to a more open, liberal society. Globalization would be coming into town," said Wuttke, who has been doing business here for most of the past four decades, and lobbying for European companies as head of the European Chamber of Commerce for part of that time.

Today, he says, the Communist Party has become more dominant across society than he thinks it was when he first came to China before reform and opening really started to take off.

"For Xi Jinping, it's clear ideology trumps the economy," he says of China's current leader.

He says that's underpinned an intrusion of politics into business.

Chinese leader Xi Jinping reviews the honor guard at the Great Hall of the People in November in Beijing. Florence Lo/Pool/Getty Images hide caption

Chinese leader Xi Jinping reviews the honor guard at the Great Hall of the People in November in Beijing.

"You have party cells coming up into Chinese private enterprises. You have a far more [and] stronger party awareness on TV or radio than it was maybe in '82. So, yeah, it's, it's more ideologically driven these days than it was 40 years ago," he said.

Combined with geopolitical frictions, Wuttke says it has become "far more complex" to steer any company in China.

In November, quarterly data showed that foreign direct investment in China contracted for the first time on record. Business confidence is down, and the real estate sector is struggling, underpinning weak consumer confidence. The future is less certain than it always seemed to be. The World Bank forecasts that China's GDP growth will slow sharply in the next two years.

"I think the opening-eye moment for me came in 2022," Wuttke says. It was a year when the government hewed for too long to an unbending and unforgiving zero-COVID policy that involved heavy travel restrictions, snap lockdowns and forced quarantines. Wuttke is leaving China, though he says his decision has nothing to do with current events.

In Shanghai, that policy turned a high school teacher into an exiled dissident.

Huang Yicheng taught Chinese language and literature in a northwestern suburb of the country's most cosmopolitan city. He says he was always in favor of the idea of more freedom, but as someone who grew up in China, human rights wasn't something he spent much time thinking about.

Huang Yicheng poses during an interview with Reuters in Hamburg, Germany, in April. He grew up in China and says he never really thought of leaving. But when Shanghai was locked down, he lost faith. Fanny Brodersen/Reuters hide caption

Huang Yicheng poses during an interview with Reuters in Hamburg, Germany, in April. He grew up in China and says he never really thought of leaving. But when Shanghai was locked down, he lost faith.

Instead, "if I could live normally, go to work, have some fun, be with my family, make some money, eat, then it'd all be fine," he said.

But in the spring of 2022, the omicron variant of COVID-19 arrived and the Shanghai government ordered its 26 million residents to stay home to stop the spread. A lockdown that the authorities said would last about a week stretched for two long months.

Huang says being forcibly confined to his home felt like living on an animal farm. He felt unsafe being locked in his apartment with no control, and no end in sight. "It was really scary," he said. "It didn't feel safe."

And it changed something inside him.

"Before the lockdown, I thought Shanghai would be fine," he said. "There was a lot of bad news about the pandemic, and I knew things weren't great, but I thought bad things could happen in other places but Shanghai still had hope."

When his city was locked down, he lost faith.

"I thought everything was fake. The security and order and freedom, it could all be taken away. So I had no faith in this government, in this political system."

Later that year, when protests erupted in Shanghai and elsewhere in China against the draconian COVID policies, Huang got involved. The demonstrations became known as the White Paper Revolution, because many participants took to brandishing blank pages of A4-size paper to symbolize all that could not be said publicly in China.

Protesters hold up blank sheets of paper and chant slogans as they march to protest strict anti-virus measures in Beijing on Nov. 27, 2022. Thousands of people demonstrated across China, waving sheets of white paper to represent the country's strict censorship. Ng Han Guan/AP hide caption

Protesters hold up blank sheets of paper and chant slogans as they march to protest strict anti-virus measures in Beijing on Nov. 27, 2022. Thousands of people demonstrated across China, waving sheets of white paper to represent the country's strict censorship.

"The white paper movement really made me feel hopeful," he said. "Finally, Chinese people were coming out to resist."

He joined a crowd at an intersection in Shanghai's former French concession neighborhood, where protests had taken place the previous night. Huang says he mostly hung back. But when police cleared protesters that night, he was grabbed, roughed up and briefly detained.

Months later, after lying low, he fled to Germany.

"I had never really thought of leaving. Really. I thought, if this country's not good, you don't necessarily need to leave it. You can stay and do some small things to make change," he said.

Instead, the pandemic changed him.

Back in Xi'an, a man whom NPR first talked with a year ago is settling into his new home.

Last year, Lee Shin was squatting in an unfinished apartment he had bought nine years earlier. It was on the 28th floor and there was no electricity.

"We used a tank gas stove, and we had to fetch bottles of water from downstairs," he said. (Lee Shin is a nonstandard Romanization of a nickname he asked NPR to use because police have pressured him not to speak publicly about the construction problem at his apartment complex.)

Not long after Lee bought the unfinished apartment, construction stopped when the property developer allegedly lost money in other investments.

The problem of unfinished apartment complexes is widespread in China and the projects are called lanwei lou, Chinese for "rotten tails."

This year, the building was finally completed and Lee and his wife could fully move in. But after so many years of uncertainty, it was a letdown.

"So when we got the key and opened the door, there was no feeling of excitement. When we went in, we just wanted to cry," he says.

Outside the apartment complex where Lee Shin and his wife finally moved in after years of delay. Not long after Lee bought the unfinished apartment, construction stopped when the property developer allegedly lost money in other investments. John Ruwitch/NPR hide caption

Outside the apartment complex where Lee Shin and his wife finally moved in after years of delay. Not long after Lee bought the unfinished apartment, construction stopped when the property developer allegedly lost money in other investments.

His life plans for an early wedding, for kids were set back by years. And home prices have been falling in China amid a slow-motion crisis unfolding in the property sector, driven in part by government policies. It's unclear how the authorities will manage the fallout from collapsing developers and falling home prices.

But now, finally in their new home, surely things were looking up for Lee and his wife?

He says he has more peace in his life, for the most part. But work is bad in his field of interior design because of the property downturn, and his ambitions have been tempered. Among other things, he says he does not want to have a child now.

"I don't have any aspirations, and I don't think I want to have any aspirations anymore," he said. "None of my wishes have come true."

Aowen Cao contributed reporting from Beijing.

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China struggles to rebound a year after lifting COVID restrictions - NPR

Featured story Health care renewals are underway

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