“Power is of two kinds. One is obtained by the fear of punishment and the other by acts of love. Power based on love is a thousand times more effective and permanent then the one derived from fear of punishment”
Mahatma Gandhi

“All the forces in the world are not so powerful as an idea whose time has come”
Victor Hugo

“Power is like being a lady… if you have to tell people you are, you aren’t”
Margaret Thatcher

“Knowledge is power”
Francis Bacon

“The greater the power, the more dangerous the abuse”
Edmund Burke


It is appropriate that at a time of the great political events unfolding around us, that we could explore the notion of power. We often think of power in terms of governance, leaders and inequality; both its benefits and misuse. In Sonnet 94 Shakespeare tells us that the perfect exercise of power is by those individuals who have the ability to hurt others but who apply their power wisely “They that have power to hurt, and will do none, That do not do the thing they most do show”.
Power can also be personal, as Emily Dickenson describes in the first of two poems, “To be alive is Power, Existence in itself”. In the second poem she muses over the problem of limits to her personal power and the subsequent consequences.
Abstract concepts can exert power on individuals and society, such as love, language, rhetoric, memory, music and the arts. Letitia Elizabeth Landon writing in the 19th century in her poem, “The Power of Words” said “Tis a strange mystery, the power of words. Life is in them, and death”
I have tried to explore some of these ideas in the work of the nine poets below. Please enjoy!

William Shakespeare (1564-1616)
William Shakespeare was the great English playwright, poet, and actor, widely regarded as the greatest writer in the English language and the world’s greatest dramatist. He is often called England’s national poet and the “Bard of Avon”. As I have said before, there is a Shakespeare sonnet for every occasion and every theme.
This sonnet is one of the most challenging of the whole of Shakespeare’s cycle. Many believe that it is one of his greatest. The poet, J H Prynne even wrote a whole book about it. I quote Oliver Tearle, whose short analysis reads thus:
“There are those who have the power to hurt others, because of the beauty they possess; but they don’t hurt anyone, even though they can. They inspire sexual desire in those, but are themselves cool and unaffected, and not easily tempted. These people deserve our praise, and that of heaven, too. They are like lords in their greatness, who own it outright; we others are like stewards who merely look after their excellence. The flower that blooms in the summer is sweet, even though the flower itself neither knows nor cares how sweet it is; but if that sweet flower is infected, then even the lowliest weed is more dignified and honourable. Sweet things which turn sour, do so because they become corrupted; weeds are preferable to rotting and festering lilies.”

Sonnet 94

They that have power to hurt, and will do none,
That do not do the thing they most do show,
Who, moving others, are themselves as stone,
Unmoved, cold, and to temptation slow;
They rightly do inherit heaven’s graces,
And husband nature’s riches from expense;
They are the lords and owners of their faces,
Others, but stewards of their excellence.
The summer’s flower is to the summer sweet,
Though to itself, it only live and die,
But if that flower with base infection meet,
The basest weed outbraves his dignity:
For sweetest things turn sourest by their deeds;
Lilies that fester, smell far worse than weeds.

William Shakespeare: Sonnet 94

Letitia Elizabeth Landon (1802 –1838)
Letitia Elizabeth Landon was a prolific English poet and novelist, often known as L.E.L. among fans and in literary circles. She was born on August 14, 1802 in Chelsea. The eldest of three children, Landon showed literary talent at nine years old; her first published work, the poem “Rome,” appeared in in the Literary Gazette March 11, 1820, and her work continued to be published in the periodical under the initials “L.” and “L.E.L.” The following year, with financial support from her grandmother, Landon published The Fate of Adelaide: A Swiss Tale of Romance; and Other Poems; the collection was the first of her works to be published under her full name and sold well, though it received little critical attention. In addition to publishing her work in the Gazette, Landon served as the journal’s chief reviewer and had considerable influence on both book sales and literary reputations.

The Power of Words

Tis a strange mystery, the power of words!
Life is in them, and death. A word can send
The crimson colour hurrying to the cheek,
Hurrying with many meanings; or can turn
The current cold and deadly to the heart.
Anger and fear are in them; grief and joy
Are on their sound; yet slight, impalpable:—
A word is but a breath of passing air.

Letitia Elizabeth Landon: The Power of Words

Anne Bronte (1820-1849)
Anne Brontë was an English novelist and poet, the youngest member of the Brontë literary family. The daughter of Patrick Brontë, a poor Irish clergyman in the Church of England, Anne Brontë lived most of her life with her family at the parish of Haworth on the Yorkshire moors.
She attended a boarding school in Mirfield between 1836 and 1837. At 19 she left Haworth and worked as a governess between 1839 and 1845. After leaving her teaching position, she fulfilled her literary ambitions. She published a volume of poetry with her sisters in 1846 and two novels. “Agnes Grey”, based upon her experiences as a governess, was published in 1847. Her second and last novel, “The Tenant of Wildfell Hall”, which is considered to be one of the first sustained feminist novels appeared in 1848. Like her poems, both her novels were first published under the masculine pen name of Acton Bell. Anne’s life was cut short when she died of what is now suspected to be pulmonary tuberculosis at the age of 29. Together with her two sisters, Charlotte (who wrote Jane Eyre) and Emily (who wrote Wuthering Heights) they became one of the most successful and famous literary families in the English-speaking world.
The power of love was written under the pseudonym Albert Exina. Although it was written in 1846, it was not published until 1917
The power of love is a recurring theme in poetry and popular music. Here Anne tells us that love gives us power to transcends whatever life throws at us

The Power of Love

Love, indeed thy strength is mighty
Thus, alone, such strife to bear —
Three ‘gainst one, and never ceasing —
Death, and Madness, and Despair!

‘Tis not my own strength has saved me;
Health, and hope, and fortitude,
But for love, had long since failed me;
Heart and soul had sunk subdued.

Often, in my wild impatience,
I have lost my trust in Heaven,
And my soul has tossed and struggled,
Like a vessel tempest-driven;

But the voice of my beloved
In my ear has seemed to say —
‘O, be patient if thou lov’st me!’
And the storm has passed away.

When outworn with weary thinking,
Sight and thought were waxing dim,
And my mind began to wander,
And my brain began to swim,

Then those hands outstretched to save me
Seemed to call me back again —
Those dark eyes did so implore me
To resume my reason’s reign,

That I could not but remember
How her hopes were fixed on me,
And, with one determined effort,
Rose, and shook my spirit free.

When hope leaves my weary spirit —
All the power to hold it gone —
That loved voice so loudly prays me,
‘For my sake, keep hoping on,’

That, at once my strength renewing,
Though Despair had crushed me down,
I can burst his bonds asunder,
And defy his deadliest frown.

When, from nights of restless tossing,
Days of gloom and pining care,
Pain and weakness, still increasing,
Seem to whisper ‘Death is near,’

And I almost bid him welcome,
Knowing he would bring release,
Weary of this restless struggle —
Longing to repose in peace,

Then a glance of fond reproval
Bids such selfish longings flee
And a voice of matchless music
Murmurs ‘Cherish life for me!’

Roused to newborn strength and courage,
Pain and grief, I cast away,
Health and life, I keenly follow,
Mighty Death is held at bay.

Yes, my love, I will be patient!
Firm and bold my heart shall be:
Fear not — though this life is dreary,
I can bear it well for thee.

Let our foes still rain upon me
Cruel wrongs and taunting scorn;
‘Tis for thee their hate pursues me,
And for thee, it shall be borne!
Anne Bronte – The Power of Love

Emily Dickinson (1830-1886)
Emily Elizabeth Dickinson was an American poet. Little known during her life, she has since been regarded as one of the most important figures in American poetry. Dickinson was born in Amherst, Massachusetts. I return once again to this remarkable poet for inspiration. I include 2 poems about power.
The poems are typical of Emily Dickenson, with simple language but profound meaning. In the first poem, she tells us that being alive radiates power and to exist at all is a powerful miracle. She focuses on the life of the individual, this poem reminds us that we all have power, if we can only find a way of wielding it.

To be alive—is Power—
Existence—in itself—
Without a further function—

To be alive—and Will!
‘Tis able as a God—
The Maker—of Ourselves—be what—
Such being Finitude!

To be alive – is Power –

In the second poem she alludes to the biblical story of David and Goliath, when the small boy with a simple slingshot killed the giant. She tells us that she faced an even greater giant when she “went against the world” but sadly her attempt was not successful. She ends with pondering whether the dream (Goliath) was too large for her to achieve or if she was just not powerful enough to achieve it.

I took my Power in my Hand—
And went against the World—
‘Twas not so much as David—had—
But I—was twice as bold—

I aimed by Pebble—but Myself
Was all the one that fell—
Was it Goliath—was too large—
Or was myself—too small?

I Took My Power In My Hand – Emily Dickinson

George Santayana (1863 –1952)
Jorge Agustín Nicolás Ruiz de Santayana y Borrás, known in English as George Santayana, was a philosopher, essayist, poet, and novelist. Originally from Spain, Santayana was raised and educated in the US from the age of eight and identified himself as an American, although he always retained a valid Spanish passport.
When I first read this, the style made me think that I was dealing with a much earlier poet. Santayana tells us that beauty is in the hands of the gods and is transitory, we as artists “show but what one happy moment saith” but we can immortalise that moment so that “The sacred past that should not pass away” He is quoted as saying that “Art supplies constantly to contemplation what nature seldom affords in concrete experience – the union of life and peace”

The Power of Art

Not human art, but living gods alone
Can fashion beauties that by changing live,–
Her buds to spring, his fruits to autumn give,
To earth her fountains in her heart of stone;
But these in their begetting are o’erthrown,
Nor may the sentenced minutes find reprieve;
And summer in the blush of joy must grieve
To shed his flaunting crown of petals blown.
We to our works may not impart our breath,
Nor them with shifting light of life array;
We show but what one happy moment saith;
Yet may our hands immortalize the day
When life was sweet, and save from utter death
The sacred past that should not pass away.

W.H. Auden (1907-1973)
Wystan Hugh Auden was an Anglo-American poet. He was admired for his technical ability to write poems in nearly every imaginable verse form. He wrote about popular culture and current events.
This short poem of only 6 lines was inspired by the appalling events of the 1930’s, but it also neatly encapsulates the qualities and behaviour of all tyrants. W. H. Auden spent some time in Berlin during the 1930s, and it was here that he probably wrote ‘Epitaph on a Tyrant’, which was published in 1939, the year that the Second World War broke out. The specific tyrant Auden had in mind, then, was probably Adolf Hitler, though the poem can be analysed as a study in tyranny more generally, too.

Epitaph on a Tyrant

Perfection, of a kind, was what he was after,
And the poetry he invented was easy to understand;
He knew human folly like the back of his hand,
And was greatly interested in armies and fleets;
When he laughed, respectable senators burst with laughter,
And when he cried the little children died in the streets.

W.H. Auden “Epitaph On A Tyrant”

Brian Dorn
Brian Dorn has been publishing rhyming-poetry on the internet for several years. He comes from Ballston Spa, NY and graduated from The University of Albany. Brian has effectively used cyberspace to circulate his clever wordplay throughout an increasingly paperless world. Thanks to the web, Brian Dorn’s poetry has reached an audience far beyond upstate NY. Brian has authored hundreds of poems, many of which can be found in his two-volume collection, From My Poems to Yours. The poem speaks for itself

Dying for Power

Fighting wars just like before
Hate to think how many more
Hour by hour, dying for power
Digging graves and laying flowers
killing men again and again
That’s the way its always been

Mary Havran
Sorry but I can’t find much about Mary Havran. The poem speaks for itsself though.

The Power Of One

One second might not tell
When held against an hour
One hour might not count
When weighed against a day
One day may not matter
When considering a life

One word may mean little
From the conversation whole
One line may not be missed
When stricken from the book
One thought may be dismissed
In comprehension of the mind

One flaw might be overlooked
When evaluating character
One mistake means little
When summing up a man
One sin may be forgiven
In the judgement of a soul

So how is it a single glance
Can make one wither so?

Richard Nnoli
Finally, lets concentrate on “People Power” or in John Lennon’s words “Power to the People”.
I cant find out much about the African poet, Richard Nnoli but I believe that this is a fitting finale to our journey through so many viewpoints of power
Richard Nnoli said “Am an African not an African’t” and his response was
“Yes, We Can!”

The people power

The people power
What is the use of leaders
If the people are not free

How is it possible this protests
On the streets everywhere
In our so called third world

Who is to set who free

From what to what

How come we must fight

Fighting just to be free

How is this possible
We are still on same
Oh Africans

Here you see the value
Of people unity
People togetherness
For there is no leader
Without the people

Now how is it possible
We are still not free

The freedom we need
Lies on our change of now
To unity Only till then
We gladly can have
the people power

For When the power is no
Longer on the hands of few
The world can truly change
For then will be
The people power
A future change yet not achieved
A part of my dream
As I dreamed

Some songs about power

John Lennon- Power to the people

Patti Smith – People Have The Power

Céline Dion – The Power Of Love

Woody Guthrie- This Land Is Your Land

Labi Siffre – Something Inside So Strong

Today’s Posts

Please take at a video on Facebook, sent to me by the Chair of the Wonca Working Party on Mental Health, Chris Dowrick on Mental Health and Covid-19
S Mental

New articles published in Rural and Remote Health:
6042 – Asia – Elders suffering recurrent injurious falls: causal analysis from a rural tribal community in the eastern part of India
Recurrent injurious falls are among the elderly in tribal areas of eastern India. Along with the incidence of unintentional injurious falls, this study also reports on the factors responsible. The findings suggest that proper nutrition and regular check-ups and rehabilitative measures are needed to reduce the frequency of recurrent falls.
5933 – Latin America – Rural and urban disparities in oral hygiene practices among Peruvian children aged less than 12 years: Demographic and Family Health Survey 2018
The adoption of adequate oral hygiene practices is important for the maintenance of good oral health in children. This study examined rural–urban differences and associated sociodemographic factors in oral hygiene practices in Peruvian children under twelve years of age.
5930 – Australasia – Clonidine for pain-related distress in Aboriginal children on a penicillin regimen to prevent recurrence of rheumatic fever
Indigenous children and adolescents in Australia and globally bear the burden of acute rheumatic fever (ARF), although it has been virtually eliminated in well-resourced, developed settings. Adherence to the schedule of intramuscular penicillin injections used to manage ARF has been reported as difficult due to the painful nature of the injections, the long timeframes of the prescription, young age of patients, access problems and costs in some locations. This Clinical Case Report reports on the use of clonidine for reducing pain-related distress and facilitating adherence to the penicillin regimen.
5710 – Europe – Ιdentifying patient-related barriers in hypertension control: a multi-centered, mixed-method study in Greek rural practices
The findings of this multi-centered, mixed-method study suggest that physicians should be aware of the possible disconnection between their patients’ perceived and actual blood pressure control. Knowledge gaps, intolerance of adverse events, negligence, unmet individual preferences, financial barriers and overtreatment of hypertension are among the identified barriers.
5769 – Australasia – Growing the pool of rural general practitioners
Although critically important for maintaining a healthy population, primary health care is not always easily accessible, particularly in rural regions. This is partly due to an insufficient number of medical graduates entering and being retained in the rural workforce. This Commentary discusses key elements of international and national programmes designed to address this shortfall.
6132 – Australasia – Teaching psychomotor skills online: exploring the implications of novel coronavirus on health professions education
The safe and effective application of psychomotor skills in the clinical environment is a central pillar of the health professions. The current global coronavirus pandemic has significantly impacted routine face-to-face skill education for health professionals and clinical students worldwide, a problem familiar to regional, rural and remote health professionals and students. This Commentary considers how the problem of physical distance might be overcome, so that quality skill education might continue.

1. UK: University of Southampton: Video: Understanding and Living with Covid-19: Past present and future?
Professor Sir Stephen Holgate said “COVID-19 has caught us all by surprise. From the experience being gained both personally and in the wider environment there are important lessons to be learnt not only about this virus, but about how society ensures we are best prepared to cope now and into the future.” More info on Distinguished Lectures: https://www.southampton.ac.uk/news/ev… Professor Holgate gives insight from a recent Government report created by 37 experts by the request of the Government’s Chief Scientific Advisor on a potential new wave of COVID-19 this winter.

S ED Video

2. Nature: Trump’s latest order spreads fear among government scientists
The directive could make it easier to fire some agency researchers and hire others for political reasons.
An executive order issued by US President Donald Trump has sown confusion and fear among government scientists in the country. Announced by the White House on 21 October, the order creates a job category for government workers — such as scientists — that makes it easier to fire people shifted into these positions. Researchers fear that this is yet another attack in a four-year war on science waged by the Trump administration. “I’ve read it over a few times, and it’s pretty frightening,” says one senior scientist at the Environmental Protection Agency (EPA), who wished to remain anonymous to protect their job. The broadness of the order is of particular concern, the scientist says, noting that it appears to make it easier to “get rid of people who don’t toe the right political line”. According to the order, workers to be tapped for the new category are those in “confidential, policy-determining, policy-making, or policy-advocating” roles. This could include scientists who help to craft policies on issues such as environmental regulation. It is not yet clear which workers would be placed in this category, but agency leaders have been given 90 days to create a preliminary list of positions that might be affected — due just one day before Trump would be inaugurated, if he was re-elected during the current US presidential race. If Trump loses to former vice-president Joe Biden, Biden could quickly overturn the order.

Denmark: BBC: Coronavirus: Denmark imposes lockdowns amid mink covid fears
Danish authorities have said a lockdown will be introduced in some areas over a coronavirus mutation found in mink that can spread to humans.
The government has warned that the effectiveness of any future vaccine could be affected by the mutation. Bars, restaurants, public transport and all public indoor sports will be closed in seven North Jutland municipalities. The restrictions will come into effect from Friday and initially last until 3 December. It comes soon after an announcement that Denmark would cull all its mink – as many as 17 million.
The Scandinavian country is the world’s biggest producer of mink fur and its main export markets are China and Hong Kong. Culling began late last month, after many mink cases were detected. On Thursday, the World Health Organization said mink appear to be “good reservoirs” of coronavirus. It also commended Denmark’s “determination and courage” for going ahead with the culls, despite the economic impact it would bring.

3. Denmark: STATNews: Spread of mutated coronavirus in Danish mink ‘hits all the scary buttons,’ but fears may be overblown
Denmark set off alarm bells this week with its announcement that it is culling the nation’s entire mink herd — the largest in the world — to stop spread of the SARS-CoV-2 virus in the prized fur species because of potentially dangerous mutations.
Inter-species jumps of viruses make scientists nervous — as do suggestions of potentially significant mutations that result from those jumps. In this case, Danish authorities say they’ve found some genetic changes that might undermine the effectiveness of Covid-19 vaccines currently in development.
But is this latest twist in the Covid-19 saga reason to be deeply concerned? Several experts STAT consulted suggested the answer to that question is probably not.
“This hits all the scary buttons,” noted Carl Bergstrom, an evolutionary biologist at the University of Washington. But Bergstrom and others argued that while the virus’s penchant for infecting mink bears watching, it isn’t likely to lead to a nightmare strain that is more effective at infecting people than the current human virus.

4. UK: Patient Safety and Learning Hub: Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study (28 October 2020)
Healthcare workers and their families account for 17% of hospital admissions for COVID-19 in the working age population (18-65 years), finds new research published in the BMJ. Shah et al. assessed the risk of hospital admission for COVID-19 among patient facing and non-patient facing healthcare workers and their household members. The study revealed that healthcare workers in patient-facing roles were around three times more likely to be hospitalised with the virus than the general population. The authors call for an urgent focus on how COVID-19 spreads around hospitals to prevent a similar toll in future waves of the pandemic. They also call for hospitals to consider re-deploying staff with vulnerable family members away from high-risk zones.

5. Science: Editorial: COVID-19: All the wrong moves in all the wrong places
In this Editorial, Barrett and Yaffe highlight shortcomings in our collective response to the COVID-19 pandemic and underscore the need for more basic research into this new disease.
As the world continues to be ravaged by coronavirus disease 2019 (COVID-19), three major systemic failures appear to have coalesced to block progress in disease control, containment, and treatment. These failures reflect a “perfect storm” of governmental ineptitude, scientific ignorance/misprioritization, and the abdication of medical training to market-driven forces. Much has already been written about the dismantling of preexisting governmental panels and organizations charged with the oversight of emerging infectious diseases by the current administration, which, when combined with lies, denial, and willful disregard for the opinions of its own cadre of expert scientists, physicians, and public health officers, has resulted in regional pandemonium and the lack of a clear national health COVID-19 policy. Whether, as with the 1918 influenza pandemic, we will see a second wave of COVID-19 with a markedly increased killing power this fall remains to be seen, but wishful thinking that COVID-19 will mysteriously vanish is both unfounded and dangerous.
Unfortunately, blame for the poor response to the COVID-19 pandemic also resides with the scientific and medical establishments. A nearly monomaniacal focus on diagnostic testing using nucleic acid reagents and antibody-based serology tests reflects the current thinking of limiting transmission as the main mechanism for disease control. However, we know that some patients with clear symptoms of COVID-19 have one or two negative test results before testing positive, which is suggestive of intermittent viral shedding, whereas others may continue to test positively during convalescence due to shedding of degraded virions, when, in fact, they may no longer be contagious. This testing conundrum is not an indictment of the assays themselves. Instead, it reflects our basic ignorance of viral-host dynamics. More worrisome is the observation that, just like with the 1918 influenza, people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can actively transmit the virus to others before they develop any particularly noticeable symptoms. These diagnostic difficulties, especially when compounded by the lack of a uniform national policy on quarantine, prevention, or risk that would actually make good use of these data, suggest that perhaps it is time to consider alternative measures for conquering the disease.

6. USA: Nature: Four ways Trump has meddled in pandemic science — and why it matters
How US President Donald Trump and his administration have silenced scientists, meddled in their reports and ignored their advice.
As the United States votes today on who will be its next president, Donald Trump’s response to the COVID-19 pandemic looms large. One issue that resonates with the research community is the extent to which the current president and his administration have meddled with science and scientific advice during the pandemic — often with disastrous results. Last month, a coronavirus-crisis sub-committee within the US House of Representatives released a report documenting 47 instances in which government scientists had been sidelined or their recommendations altered. And the report notes that the frequency of meddling has been increasing in the lead-up to the US election. “It’s hard to express how unbelievably demoralizing this experience has been,” says Diana Zuckerman, president of the National Center for Health Research, a non-profit organization in Washington DC. If Trump wins a second term, researchers fear what that could mean for public health and the scientific enterprise. If Democratic challenger and former vice-president Joe Biden wins, he’ll have his work cut out for him to restore the reputation of the US science agencies that Trump has damaged.

7. BMJ: Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study
Objective: To assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.
Conclusions: Healthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.

8. Science: Prospects for a safe COVID-19 vaccine
Rapid development of an efficacious vaccine against the viral pathogen severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of the coronavirus disease 2019 (COVID-19) pandemic, is essential, but rigorous studies are required to determine the safety of candidate vaccines. Here, on behalf of the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Working Group, we evaluate research on the potential risk of immune enhancement of disease by vaccines and viral infections, including coronavirus infections, together with emerging data about COVID-19 disease. Vaccine-associated enhanced disease has been rarely encountered with existing vaccines or viral infections. Although animal models of SARS-CoV-2 infection may elucidate mechanisms of immune protection, we need observations of enhanced disease in people receiving candidate COVID-19 vaccines to understand the risk of immune enhancement of disease. Neither principles of immunity nor preclinical studies provide a basis for prioritizing among the COVID-19 vaccine candidates with respect to safety at this time. Rigorous clinical trial design and postlicensure surveillance should provide a reliable strategy to identify adverse events, including the potential for enhanced severity of COVID-19 disease, after vaccination.

9. Science: THE SCIENCE OF SUPERSPREADING: Why preventing hot spots of transmission is key to stopping the COVID-19 pandemic
In late February, drug company Biogen held its annual conference in Boston. The United States had fewer than 20 known COVID-19 cases at the time. But one of the roughly 200 attendees must have carried the virus.
It triggered a big outbreak. At least 97 people who attended the conference, or lived in a household with someone who did, tested positive.
The Biogen meeting had become a superspreading event. Eventually, the virus spread from the meeting across Massachusetts and to other states. A recent study estimates it led to tens of thousands of cases in the Boston area alone.

10. Slovakia: Reuters: Over 2.5 million Slovaks take part on first day of nationwide COVID-19 testing
Nearly half of Slovakia’s entire population took COVID-19 swabs on Saturday, the first day of two-day nationwide testing the government hopes will help reverse a fast rise in infections without a hard lockdown. The scheme, a first in a country of comparable size, is being watched by other nations looking for ways to slow the virus spread and avoid overwhelming their health systems. Defence Minister Jaroslav Nad said on Sunday 2.58 million Slovaks took the test on Saturday, and 25,850 or 1% tested positive and must go into quarantine. The European Union country has 5.5 million people and aims to test as many as possible, except for children under 10.
More than 40,000 medics and support teams of soldiers, police, administrative workers and volunteers staffed around 5,000 sites to administer the antigen swab tests. The testing was free and voluntary, but the government will impose a lockdown on those who do not participate, including a ban on going to work.

11. Nature: Are infections seeding some cases of Alzheimer’s disease?
A fringe theory links microbes in the brain with the onset of dementia. Now, researchers are taking it seriously. Two years ago, immunologist and medical-publishing entrepreneur Leslie Norins offered to award US$1 million of his own money to any scientist who could prove that Alzheimer’s disease was caused by a germ. The theory that an infection might cause this form of dementia has been rumbling for decades on the fringes of neuroscience research. The majority of Alzheimer’s researchers, backed by a huge volume of evidence, think instead that the key culprits are sticky molecules in the brain called amyloids, which clump into plaques and cause inflammation, killing neurons. Norins wanted to reward work that would make the infection idea more persuasive. The amyloid hypothesis has become “the one acceptable and supportable belief of the Established Church of Conventional Wisdom”, says Norins. “The few pioneers who did look at microbes and published papers were ridiculed or ignored.” In large part, this was because some early proponents of the infection theory saw it as a replacement for the amyloid hypothesis. But some recent research has provided intriguing hints that the two ideas could fit together — that infection could seed some cases of Alzheimer’s disease by triggering the production of amyloid clumps.

12. India: Basic Healthcare Services: Newsletter
Six months after the pandemic was declared and lockdown was first announced, adverse impact on lives of tribal, high-migration communities continue. We are seeing an overwhelmingly larger numbers of patients presenting at our clinic, in advanced stages. On account of loss of livelihoods, erratic transport and many facilities reducing the scope of services, many families are falling through the cracks, resulting in delay or disruption of treatment. We are also seeing reduced availability of food and increasing levels of malnutrition among children. While COVID-19 is insidiously rising in areas we serve, we also witnessed rising cases of malaria, including the deadlier falciparum malaria in the region. We are also witnessing an increase in contraceptive and other reproductive health needs among the women, as well as increasing domestic violence, probably related to many migrant men having returned home.
Our presence within the communities and the trust has enabled us to continue to respond to the situation. We have been detecting and managing almost double the numbers of patients with tubercuolsis, taking full-scale measures to prevent and manage the malaria epidemic, promoting childcare and nutrition through Phulwaris, and household food availability through kitchen gardens. Coronavirus got some of our staff and their family members during this period, but that did not deter us. We realize it is a long haul, and we are gearing ourselves for staying on with even more energy and commitment. So much more needs to be done, and there is a need for organizations to come together and make the healthcare ecosystem more responsive.
At this point, we would like to express our gratitude to all of you for your wishes, support and prayers. It gives us immense strength.

13. Nature: Coronavirus testing finally gathers speed
The imminent large-scale rollout of rapid coronavirus tests promises to aid public health responses to COVID-19 — but a rapid home test remains elusive.
New SARS-CoV-2 rapid tests, which can deliver results in a matter of minutes in the field rather than taking days in clinical diagnostic labs, are starting to become widely available. They are based on a variety of technologies and formats, both old and new: conventional antigen-based tests for detecting viral proteins; polymerase chain reaction (PCR) assays for detecting viral genomic material; and newer CRISPR-based diagnostic tests, which also detect viral genomes but in fewer steps and dispensing with PCR machines. Rapid tests are easy to use: they can be deployed in high-risk environments, such as care homes or educational institutions, and by personnel with little or no specialist training. Some will be suitable for home use as well, once given the go-ahead by regulators. Collectively, they promise to be a useful adjunct to lab-based PCR diagnostic testing and, if deployed effectively and at scale, could strengthen flagging containment efforts by quickly identifying new outbreaks before they spread. The need is urgent. In recent weeks, numbers of confirmed cases have started to climb sharply in many countries. Apart from a handful of states that have curbed the spread of the SARS-CoV-2 virus, the rising numbers point to the widespread failure of efforts to contain the virus. Inadequate test-and-trace systems and insufficient compliance with recommended safety measures have allowed the virus to continue to propagate widely.

14. Nature: The US has left the Paris climate deal — what’s next?
Other nations are stepping up targets to reduce emissions — but the world will struggle to meet its goals. Regardless of who wins the US presidential election, the United States officially pulls out of the Paris climate agreement on 4 November. The move marks a blow to international efforts to halt global warming. The landmark deal, struck in 2015, aims to limit global warming to “well below” 2 °C above pre-industrial temperatures. But in June 2017, US President Donald Trump announced that the United States — the world’s second largest emitter of greenhouse gases — would withdraw from the agreement. Nature examines how the withdrawal will affect global efforts to mitigate climate change. What is Trump’s climate legacy? Trump’s decision to pull out of the landmark accord was the first major step in his campaign to systematically roll back US federal climate policies set up during the administration of Barack Obama.Trump has since reversed dozens of climate-related regulations, including rules on air pollution, emissions, drilling and oil and gas extraction. During his first term as president, and in his re-election campaign, he made no secret of his preference for fossil fuels and the industry which provides them. A report by the US energy department, released last month, lauds oil and gas as “providing energy security and supporting our quality of life”, without mentioning climate risks related to persistent use of carbon-rich fuels.

15. International: Forbes: What Do Countries With The Best Coronavirus Responses Have In Common? Women Leaders
Looking for examples of true leadership in a crisis? From Iceland to Taiwan and from Germany to New Zealand, women are stepping up to show the world how to manage a messy patch for our human family. Add in Finland, Iceland and Denmark, and this pandemic is revealing that women have what it takes when the heat rises in our Houses of State. Many will say these are small countries, or islands, or other exceptions. But Germany is large and leading, and the U.K. is an island with very different outcomes. These leaders are gifting us an attractive alternative way of wielding power. What are they teaching us?
Angela Merkel, the Chancellor of Germany, stood up early and calmly told her countrymen that this was a serious bug that would infect up to 70% of the population. “It’s serious,” she said, “take it seriously.” She did, so they did too. Testing began right from the get-go. Germany jumped right over the phases of denial, anger and disingenuousness we’ve seen elsewhere. The country’s numbers are far below its European neighbors, and there are signs it may be able to start loosening restrictions relatively soon.

16. Science: Will SARS-CoV-2 become endemic?
Reinfection, in which an individual is subject to multiple, distinct infections from the same virus species throughout their lifetime, is a salient feature of many respiratory viruses. Indeed, the persistence and ubiquity in human society of common respiratory viruses—including influenza viruses, respiratory syncytial virus (RSV), rhinovirus, and the endemic coronaviruses—are largely due to their ability to produce repeat infection. Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the ongoing coronavirus disease 2019 (COVID-19) pandemic, a critical concern has been whether humans will experience reinfections with this pathogen, which might enable it to become endemic.
Typically, following an initial infection, the human adaptive immune system develops a suite of defenses, including memory B lymphocytes capable of producing neutralizing antibodies targeted to bind to that particular pathogen, and memory T lymphocytes that help regulate immune responses and induce death of infected cells. These adaptive immune components, particularly B cells, can produce sterilizing immunity in which the pathogen, if reintroduced to the host, is prevented from replicating within the body.

17. UK: RCGP: Management of the long term effects of COVID-19
The RCGP response and top tips for caring for our patients. A survey of RCGP members in September 2020 showed 67% of those who responded were looking after at least one patient with ongoing symptoms of COVID-19 lasting more than 12 weeks. Realising the impact of this new disease on general practice and with 81% of respondents asking for more clinical guidance to help look after these patients, on behalf of our members, we lobbied for funding of a national guideline.
Whilst NICE were being commissioned to produce this guidance, RCGP clinical policy team became aware that SIGN were also beginning to review the evidence base. To prevent 2 potentially conflicting guidelines being produced at the same time, we asked both SIGN and NICE to collaborate with us, to create a single UK wide guideline which was approved and announced on 5th October 2020. It has been acknowledged in the scope of the guidance that we are only at the beginning of understanding the ongoing effects of COVID-19 and that there is still much uncertainty surrounding it. For that reason, the NICE/SIGN/RCGP guidance will be classed as a “living guideline”, meaning it will be continually reviewed and updated in response to changing and emerging evidence. At present, there is no completely accurate indication as to how many people are experiencing persisting ill health following COVID-19. Current estimates are based on extrapolated figures, or from self-reporting of symptoms in an ap, and whilst this can give us an indication of the number, until we have a cross sectional population study, the true prevalence cannot be fully known. To aid the collection of data and to inform prevalence, the RCGP clinical policy team has also worked closely with NHS Digital and the Professional Record Standards Body (PRSB) to ensure codes will be available for us to use (in both primary and secondary care), which will help us care for our patients and inform the population based data needed to further shape the services required to fully assess and treat this disease. The definition and scope of the NICE/SIGN/RCGP guideline is published today (30th October) and we have summarised this for you below. We’ve also included some top tips to aid the care of your patients whilst waiting for the national guidance to be produced.

18. USA: NPR: A New Hippocratic Oath Asks Doctors To Fight Racial Injustice And Misinformation
First-year medical student Sean Sweat “didn’t want to tiptoe around” issues of race when she sat down with 11 of her classmates to write a new version of the medical profession’s venerable Hippocratic oath.
“We start our medical journey amidst the COVID-19 pandemic, and a national civil rights movement reinvigorated by the killings of Breonna Taylor, George Floyd and Ahmaud Arbery,” begins the alternate version of the oath, rewritten for the class of 2024 at the University of Pittsburgh School of Medicine.
It continues: “We honor the 700,000+ lives lost to COVID-19, despite the sacrifices of health care workers.”
Sweat and the other incoming first-year medical students recited this newly penned pledge, along with a traditional version of the Hippocratic oath, as part of orientation activities during their first week of medical school this fall.

19. The Lancet: Persistence of viral RNA, pneumocyte syncytia and thrombosis are hallmarks of advanced COVID-19 pathology
COVID-19 is a deadly pulmonary disease with peculiar characteristics, which include variable clinical course and thrombophilia. A thorough understanding of the pathological correlates of the disease is still missing.
COVID-19 is a unique disease characterized by extensive lung thrombosis, long-term persistence of viral RNA in pneumocytes and endothelial cells, along with the presence of infected cell syncytia. Several of COVID-19 features might be consequent to the persistence of virus-infected cells for the duration of the disease.

20. UK: Imperial College London: Coronavirus antibody prevalence falling in England, REACT study shows
Tests on more than 365,000 people in England have shown that the antibody response to the virus that causes COVID-19 wanes over time. Led by Imperial College London, analysis of finger-prick tests carried out at home between 20 June and 28 September found that the number of people testing positive dropped by 26.5% across the study period, from almost 6% to 4.4%. The downward trend was observed in all areas of the country and age groups, but not in health workers, which could indicate repeated or higher initial exposure to the virus, the authors suggest. The decline was largest in people aged 75 and above compared to younger people, and also in people with suspected rather than confirmed infection, indicating that the antibody response varies by age and with the severity of illness. People in London had the highest proportion of positive tests across the country, at around twice the national average. Health and care workers, ethnic minority groups, and those living in deprived areas and large households also had the greatest burden of past infection

21. Afghanistan: Norwegian Refugee Council: The girls in the Afghan dream academy
Forty pairs of shoes are neatly lined up on a concrete staircase outside a simple grey entrance door. This is no ordinary school. It is the home of a generous neighbour who has made parts of her house available to 40 girls dreaming of an education and a profession.
Most of the girls are between 10 and 16 years old and come from families forced to flee the conflict in Afghanistan. Now they are participating in a programme organised by the Norwegian Refugee Council (NRC), where they have the opportunity to make up for lost schooling.They want to be teachers, doctors and everything else that girls dream of becoming.
Unable to read. “Most of the girls couldn’t read when they started. Many had given up hope of receiving an education. They were discouraged, passive and difficult to engage in conversation. Some were almost apathetic, while others were aggressive and rebellious,” says Raihana Nayebi, who leads NRC’s education projects in Faryab province.

22. Canada: McMaster University: To measure the severity of COVID-19, researchers create a tool that can pull an elusive marker from human blood
When COVID-19 attacks, the immune system produces a cytokine, or protein, called Interleukin-6 (IL-6), whose concentrations can offer vital information about a patient’s level and stage of infection. But measuring the critical marker has been extremely challenging, given its nearly undetectable presence in the biological stew that makes up human blood. Existing technology has not been accurate or sensitive enough to measure concentrations of IL-6 well enough to be reliable, especially in low concentrations. Now researchers at McMaster University and SQI Diagnostics have created a surface that repels every other element of human blood except the critical cytokine, opening a timely window for understanding the progress of COVID-19 in individual patients. The McMaster researchers are working to adapt the technology to the Toronto company’s existing testing platforms, in the hope of moving it into clinical use as soon as possible. The same biosensing technology can also be used to measure other infectious and non-infectious diseases, including some cancers. The innovative surface coating is made to repel every component of blood and other complex fluids such as urine, but is dotted with microscopic islands of molecules that attract IL-6, making it possible to detect and measure IL-6 with unprecedented accuracy and sensitivity, at concentrations as low as 0.5 picograms per mL – or one half of one trillionth of a gram per mL – making it far more sensitive than existing technology.

23. International: Bloomberg: Time to Reset Expectations for World Economy With Virus Untamed
Investors banking on a coronavirus vaccine to save the world economy in 2021 need to temper their ambitions as scientists increasingly warn of a long and difficult road ahead.
While drug companies are making progress in the quest to find a cure for a disease that triggered the worst recession since the Great Depression, questions remain about how effective the first wave of vaccines would be, how easy they will be to distribute to more than 7 billion people and then how many will agree to take them.
The future for global growth relies on the answers to those questions as a new wave of the pandemic means health fears and government restrictions continue to inhibit daily life and commerce. Even when a successful immunization system does come along, it won’t be an instant economic panacea, says Chris Chapman, a portfolio manager at Manulife Investment, which manages more than $660 billion.

24. USA: NPR: Rural Wisconsin Is Hit The Hardest With Surge In COVID-19 Cases
Front-line workers in Wisconsin are dealing with a spike in coronavirus cases. One doctor says that while the surge was not unexpected, medical facilities still only have so many resources. A COVID storm is on the rise. That grim new warning comes from the governor of Illinois. Texas is another place suffering with many new cases. Residents of El Paso have been asked to stay home for two weeks to prevent cases from overwhelming hospitals there. We are going to take a closer look this morning at Wisconsin. Rural parts of that state are being hit very hard. Teresa Weiler (ph) is a nurse. She supervises the COVID unit at Marshfield Medical Center in central Wisconsin.

25. UK: McMaster University: Video: Scientists find medieval plague outbreaks picked up speed over 300 years
Researchers found that in the 14th century, the number of people infected during an outbreak doubled approximately every 43 days. By the 17th century, the number was doubling every 11 days.
McMaster University researchers who analyzed thousands of documents covering a 300-year span of plague outbreaks in London, England, have estimated that the disease spread four times faster in the 17th century than it had in the 14th century.
The findings, published today in the Proceedings of the National Academy of Sciences, show a striking acceleration in plague transmission between the Black Death of 1348, estimated to have wiped out more than one-third of the population of Europe, and later epidemics, which culminated in the Great Plague of 1665.
“It is an astounding difference in how fast plague epidemics grew,” says David Earn, a professor in the Department of Mathematics & Statistics at McMaster and investigator with the Michael G. DeGroote Institute for Infectious Disease Research, who is lead author on the study.
Earn and a team including statisticians, biologists and evolutionary geneticists estimated death rates by analyzing historical, demographic and epidemiological data from three sources: personal wills and testaments, parish registers, and the London Bills of Mortality.
It was not simply a matter of counting up the dead, since no published records of deaths are available for London prior to 1538. Instead, the researchers mined information from individual wills and testaments to establish how the plague was spreading through the population.
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26. Australia: ACRRM: Video: National Rural Health Commissioner Professor Ruth Stewart on telemedicine in rural & remote areas
In this video, National Rural Health Commissioner Professor Ruth Stewart discusses the importance of telehealth in rural and remote communities and how electronic healthcare can provide high quality care close to home. She also shares her own personal success story of how she used tele-chemotherapy in her hometown of Thursday Island in Far North Queensland when she was diagnosed with a Lymphoma In 2016.

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27. USA: The Conversation: In rural America, resentment over COVID-19 shutdowns is colliding with rising case numbers
As COVID-19 spreads through rural America, new infection numbers are rising to peaks not seen during this pandemic and pushing hospitals to their limits. Many towns are experiencing their first major outbreaks, but that doesn’t mean rural communities had previously been spared the devastating impacts of the pandemic.
Infection rates in rural and frontier communities ebbed and flowed during the first seven months, often showing up in pockets linked to meat packing plants, nursing homes or prisons. Even if they had no cases, many rural areas were under statewide public health orders that left businesses closed and events canceled. And that has become part of the problem today. The early compassionate and cohesive community responses to COVID-19 quickly gave way to growing anger and compliance fatigue, especially when some isolated towns didn’t see their first positive cases until summer.
That resentment toward public health recommendations, including mask-wearing, is now on a crash course with rising case numbers in the Mountain West, Midwest and Great Plains. For the fifth week in a row, rural counties witnessed a sharp increase in cases, to the point where over 70% of the nation’s nonmetropolitan counties had earned a “red zone” designation, suggesting local viral spread was out of control. The reality, though, is COVID-19 has never been “under control” in the U.S.
As professors of family medicine with experience in rural health policy and medical practice, we have been studying the barriers rural communities are facing during the pandemic and how they can solve COVID-19-related challenges.
Understanding the drivers of increasing COVID-19 cases in rural places is critical to both curtailing the current surge and limiting flareups in the future.

28. Nature: The race to make COVID antibody therapies cheaper and more potent
Injections of antibodies might prevent mild COVID-19 from becoming severe, but the treatments are expensive and difficult to make. When US President Donald Trump was ill with COVID-19, his physicians administered a bevy of medications — some proven, others experimental. But there is one that the president has hailed as a “cure”: a cocktail of coronavirus antibodies produced by Regeneron Pharmaceuticals in Tarrytown, New York. The ‘curative’ power of this antibody treatment has yet to be proven. Although it has shown promise in small, early studies in people with mild COVID-19 symptoms, large clinical trials have not yet been completed. Meanwhile, researchers are already designing more-advanced antibody treatments that could be cheaper, easier to produce and more potent. “What you really want is something that is so amazingly potent that you need barely any,” says biochemist Pamela Björkman of the California Institute of Technology in Pasadena. “You want to be able to give it to everybody in the house or the hospital or the school or the meat-packing plant that’s been exposed.”

29. International: The New Yorker: How the Coronavirus Hacks the Immune System
At a laboratory in Manhattan, researchers have discovered how SARS-CoV-2 uses our defenses against us. Some four billion years ago, in the shallow waters where life began, our earliest ancestors led lives of constant emergency. In a barren world, each single-celled amoeba was an inconceivably rich concentration of resources, and to live was to be beset by parasites. One of these, the giant Mimivirus, masqueraded as food; within four hours of being eaten, it could turn an amoeba into a virus factory. And yet, as the nineteenth-century mathematician Augustus de Morgan said, “Great fleas have little fleas upon their backs to bite ’em, and little fleas have lesser fleas, and so ad infinitum.” The Mimivirus had its own parasites, which sometimes followed it as it entered an amoeba. Once inside, they crippled the Mimivirus factory. This trick was so useful that, eventually, amoebas integrated the parasites’ genes into their own genomes, creating one of the earliest weapons in the immune system.
We tend to associate “survival of the fittest” with lions hunting antelope. But disease—the predation of parasites upon hosts—is actually the most potent force in evolution. “Every single phase of life has been selected to try to avoid parasitism,” Stephen Hedrick, an immunologist at the University of California, San Diego, told me. “It’s driven evolution as hard as it could be driven. Because it’s life or death all the time. And it’s a co-evolution.” Whenever a host develops an immune defense, it perversely rewards the survival of the very parasites that can defeat it. Hosts, meanwhile, tend to be at an evolutionary disadvantage. “Bacterial or viral populations are truly vast in size,” Robert Jack and Louis Du Pasquier write, in “Evolutionary Concepts in Immunology,” and the wide variation among them gives natural selection many candidate organisms upon which to work. Viruses and bacteria also reproduce half a million times faster than we do. Given this “generation gap,” Jack and Du Pasquier write, “one might well ask how on earth we could possibly have survived.”

30. Science: Europe is locking down a second time. But what is its long-term plan?
“Europe is at the epicenter of this pandemic once again,” said World Health Organization regional director Hans Kluge last week — it has surpassed the United States in cases per capita
Shortly before 11 p.m. yesterday, a waitress passed out paper cups to the customers crowded around the tables outside Luzia, a bar in the lively Kreuzberg district here. “I’m sorry, but you all have to leave,” she said. “God, in 2 minutes it’s going to be lockdown,” a woman at one table said, as guests poured the remainder of their cocktails into the cups. The fun was over: For the second time this year, Luzia had to close on the German government’s orders. All restaurants, bars, gyms, and theaters in Europe’s largest economy will remain shut until at least the end of the month in a new bid to halt the spread of COVID-19. Hotels are no longer allowed to host tourists. Residents have been asked to meet people from only one other household. Florent, the manager at Luzia, took some hope from the fact that Germany was locking down while cases were still lower than in neighboring countries. “Hopefully we’ll reopen in a month,” he said. With COVID-19 cases mounting and threatening to overwhelm health care capacity, much of Europe has taken similar measures to curb human contacts. Two months ago, as numbers began to creep up after a blissful summer lull, countries still held out hope that more limited, targeted measures could prevent a second wave. Now, that wave is here, with the force of a tsunami. Europe has surpassed the United States in cases per capita; last week, it accounted for half of the more than 3 million cases reported to the World Health Organization (WHO). “Europe is at the epicenter of this pandemic once again,” WHO’s regional director for Europe, Hans Kluge, said on 29 October. Most countries are reacting without a long-term plan, simply trying to avoid the worst. Officials differ about the best way to bring the numbers down again, and how low a level they should strive for. And no one knows what comes next. Short of vaccines to save the day, countries may face an exhausting series of lockdowns—a sawtooth pattern, “up and down and up and down,” that could wreck the economy, says Albert Osterhaus, a virologist at the University of Veterinary Medicine, Hanover. “There is no strategy in Europe,” he concludes.

31. Nature: Redesign open science for Asia, Africa and Latin America
Researchers in many countries need custom-built systems to do robust and transparent science.
Last year, my colleagues and I organized a webinar on open science, with a focus on Indonesia. One participating university experienced blackouts owing to a faulty electricity grid. At another, a generator exploded. At a third, political riots had damaged buildings.
Perhaps most people reading this article would find such constraints intolerable, but the reactions were inspiring. People regrouped and found ways to attend the webinar, or to access it later. We advertised through Twitter and by word-of-mouth and expected only a few attendees — but more than 1,000 academics, government workers, students and journalists participated. The message was loud and clear: Indonesia wants to produce good research.
Research is relatively new in many countries in Asia, Africa and Latin America. Across these regions, young scientists are working to build practices for open science from the ground up. The aim is that scientific communities will incorporate these principles as they grow. But these communities’ needs differ from those that are part of mature research systems. So, rather than shifting and shaping established systems, scientists are endeavouring to design new ones.

32. Nature: Young scientists in Malaysia have made integrity training fun and relevant
Bottom-up workshops have laid a foundation for responsible research, but institutions must add structural support.
For seven years, young researchers in Malaysia have been organizing workshops on responsible research conduct. We have reached more than 1,000 people at home and elsewhere, including Thailand, Switzerland and the United States.
We were inspired by an August 2013 workshop in Kuala Lumpur, organized by the US National Academy of Sciences and the Academy of Sciences Malaysia. Many of us wished that such training was more widespread in our country. To work out how we could provide it, I teamed up with Abhimanyu Veerakumarasivam, a geneticist at Sunway University in Subang Jaya, and Chai Lay-Ching, a microbiologist at the University of Malaya in Kuala Lumpur, with help from the US academy. Although some researchers in Malaysia were already familiar with human- and animal-research ethics, few had heard the phrase ‘responsible conduct of research’ (RCR) or received instruction in research integrity.
When I was a graduate student and postdoc in the United States, RCR training tended to be shallow discussions with few practical applications. A mandatory course merely called for me to read some material and answer a few questions. But for best practices to take root, researchers need more than rote knowledge. They need to believe these practices are important, and to be able to make ethical decisions that apply to their particular situation.

33. Argentina: Washington Post: Argentina locked down early and hard. Now cases are exploding.
When the novel coronavirus first reached Argentina, Andrés Bonicalzi steeled himself for the sacrifices to come. A lawyer in Buenos Aires, he started working from home, canceled his weekly visits with his parents and vowed to keep his son inside. The government announced one of the world’s strictest lockdowns. The next few weeks would be difficult.
But those hard weeks have turned into seven months, and much of Argentina’s lockdown, believed to be the world’s longest, is still dragging on.
So much sacrifice, Bonicalzi sometimes thinks, and for what? The South American country has become one of the coronavirus’s most explosive breeding grounds. In early August, fewer than 200,000 Argentines had contracted the virus. That number has since surged to 1.1 million — 1 out of every 44 people — and 28,000 are dead.

34. UK: HSJ: Exclusive: Hospitals 70pc more full than April
There are 70 per cent more people in hospital now as when England was approaching its spring covid-19 peak, and twice as many non-covid patients, according to official figures leaked to HSJ. In some regions, the contrast is even sharper. In the North East and Yorkshire, where covid-19 hospitalisations are still mounting rapidly, there are now twice as many patients in acute hospitals than there were in early April.
The information also shows that there are now 13 per cent more patients than there were on 3 April in mechanical ventilation beds – which are reserved for the most seriously ill patients. These include more than double the number of non-covid patients than there were in the spring. The information — shared with HSJand the Independent by NHS sources — also reveals that one in 10 hospital beds are now occupied by confirmed covid patients – up from about 6 per cent two weeks ago.
Late March saw a national cancellation of most planned care, large reductions in emergency admissions, and a huge programme to discharge patients home or to care homes. The NHS is now trying to maintain planned care where possible. Emergency activity has so far not significantly dipped this time and winter will keep it higher. There are also indications that it has become harder to discharge patients from hospital than it was in April.

35. Australia: University of Melbourne: LIVING IN THE CROSSHAIRS OF COVID-19
It’s not a particularly pleasant prospect to die from COVID-19 – but I will soon face State and Commonwealth decisions that may cost me my life
I am eighty-seven, and I have Parkinson’s Disease. If I am infected with COVID-19, I am likely to die.
For the bulk of my long life I have been behaving in ways – from my frequent use of public transport to attendance at mass events – which are now widely believed to be dangerous. So long as a means of reliable vaccination remains undiscovered, it will continue to be considered dangerous.
Although I am not a medical scientist, I have spent a lifetime in research, and I understand the processes required to undertake complex studies and produce findings. For this reason, I do not believe that such a discovery will be delivered soon, despite the urgent efforts of medical researchers.
As a retired person, I have been extremely careful to follow government instructions on how I should behave during the lockdowns we have experienced in 2020.
Of particular difficulty has been maintaining relationships with my seven grandchildren, for they have been identified as being the most prominent of the dangers confronting us.
As threatening as it is, I have long been receptive to the warning that one of my grandchildren could be a carrier but unwittingly asymptomatic and, therefore, could risk infecting me fatally.
Notwithstanding this risk, I undoubtedly will soon face State and Commonwealth decisions on behavioural matters that will probably cost me my life.
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36. USA: The Guardian: Video: Trump falsely tells Michigan rally: ‘Our doctors get more money if someone dies of Covid’
Donald Trump has attacked the doctors who have been treating coronavirus patients on the frontline of the pandemic. Speaking during a campaign rally in Waterford Township, Michigan, the US president said: ‘Our doctors get more money if someone dies from Covid. You know that, right? I mean, our doctors are very smart people.’
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37. UK: British Medical Association: Doctors with long COVID
Doctors who contracted COVID, and thought the symptoms would be over in weeks, tell Jennifer Trueland about their continuing pain, exhaustion and – sometimes – struggle to be believed
Richard Campbell had a demanding job as a consultant rheumatologist in a busy London trust at the start of the year.
In his scant spare time, he enjoyed an active social life, went to the gym several times a week, and had a particular interest in creating complex electronic music, sometimes involving up to 50 separate sounds.
When he developed symptoms of COVID-19 towards the end of March, he thought it would be a short period of feeling awful, then back to his old life. But six months later, he is still suffering – and has yet to return to work, let alone anything else.
‘I had been looking after probably COVID-19 patients and working on the medical take where I saw lots of COVID-19 patients,’ explains Dr Campbell, 44.
‘I wasn’t severely unwell enough to need to go into hospital, but I was unwell at home for two to three weeks. I had fever and severe myalgia, and very severe headaches, loss of taste and smell, severe vertigo where it felt I was constantly falling backwards, and severe tiredness. Interestingly, I never had any respiratory symptoms – I never had a cough and was never short of breath.

38. International: University of Melbourne: CLOSING THE OXYGEN ACCESS GAP
In Australia, amid the COVID-19 pandemic, we take oxygen access in our hospitals for granted. But new research is working to ‘close the oxygen gap’ globally and potentially change the world
In recent months, emergency rooms and intensive care units around the world have been overwhelmed with COVID-19 patients – bringing into sharp relief how utterly reliant we are on oxygen and how much those of us in high-income countries take it for granted.
Several years ago, I was working in a small clinic in Sudan. A small girl named Amina* was brought in, clearly very unwell with pneumonia. She was breathing fast and barely conscious. We gave her antibiotics, connected her to our sole oxygen concentrator and admitted her to the ward. Amina kept getting sicker, but other unwell patients also needed oxygen, forcing us to choose who to prioritise.
Since then, I’ve learned that oxygen access is a universal challenge for hospitals in low and middle-income countries (LMIC) like Sudan.
In fact, we estimate that every year, around 15 million children like Amina are admitted to hospital with life-threatening low blood oxygen levels due to pneumonia and other conditions in which lack of oxygen is a major contributor to death.
Nearly all of those children, 90 per cent, come from low-income countries in the African and Asia-Pacific regions where better oxygen access could prevent over half a million child deaths annually.

39. International: Aljazeera: New study links air pollution to 15 percent of COVID-19 deaths
Researchers say deaths linked to COVID-19 and air pollution represents ‘potentially avoidable, excess mortality’. Long-term exposure to air pollution may be linked to 15 percent of COVID-19 deaths globally, according to a new study. Published in the journal Cardiovascular Research on Tuesday, the research from German and Cypriot experts analysed health and disease data from the United States and China relating to air pollution, COVID-19 and SARS – a respiratory illness similar to the new coronavirus disease. The authors combined this with satellite data of global exposure to particulate matter – microscopic particles – as well as ground-based pollution monitoring networks, to calculate the extent to which air pollution could be blamed for COVID-19 deaths. In East Asia, which has some of the highest levels of harmful pollution on the planet, the authors found that 27 percent of COVID-19 deaths could be attributed to the health effects of poor air quality.The proportion was 19 percent in Europe, and 17 percent in North America.The authors said the deaths linked to COVID-19 and air pollution represented a “potentially avoidable, excess mortality” and that exposure to particulate matter in air likely aggravated “co-morbidities that lead to fatal outcomes” of infection by SARS-CoV-2, the virus that causes COVID-19.

40. USA: STAT News: FDA shows signs of cold feet over emergency authorization of Covid-19 vaccines
There are serious signs the Food and Drug Administration is getting cold feet over the notion of issuing emergency use authorizations to allow for the widespread early deployment of Covid-19 vaccines.
Instead, it appears the agency may be exploring the idea of using expanded access — a more limited program that is typically used for investigational drugs — in the early days of Covid vaccine rollouts.
Whereas a few weeks ago the agency’s concern was to protect against the possibility that unproven vaccines would be pushed out prematurely due to pressure from President Trump, now the fear is that early authorization of vaccines could squander a one-time chance to determine how well the various vaccines work and which work best in whom.

41. UK: University of Birmingham: How can we understand the role of asymptomatic transmission without a high quality antibody test?
Researchers are developing rapid virus testing solutions and evaluating tests to help create the ‘bigger picture’ in the global fight against COVID-19.
High-quality antibody tests for SARS-CoV-2 are critical to understanding how the virus spreads through the population, also supporting the development of effective vaccines and therapies. The world’s scientists are discovering more about COVID-19 every day, but it has long been clear that there is an urgent need for a test sensitive enough to detect the viral antibodies in people who have shown no symptoms. Such a ground-breaking development could identify thousands more people who have already had the virus.
Supported by the NIHR Birmingham Biomedical Research Centre, and the Institute of Global Innovation, experts at the Universities of Birmingham and Southampton have worked with leading in vitro diagnostic (IVD) company The Binding Site to create just such a test. The Birmingham test has detected antibodies in people who only suffered a mild form of COVID-19 infection. These people may have displayed very few or no symptoms, but generated an immune response to the virus.
Professor Alex Richter, from the Institute of Immunology and Immunotherapy at Birmingham, commented: “It is relatively straightforward to detect antibodies in those who have experienced severe infections, but our research has shown that those who have had a milder or asymptomatic illness, usually have weaker antibodies responses, which means that cases could be being missed by the tests currently in use.

42. Frontiers in Public Health: The Academic Response to COVID-19
COVID-19 has posed an unprecedented challenge to the international scientific community. Along with the disruption faced by most of the world’s population, many researchers have felt an added pressure to understand, cure and mitigate the virus. In order to gain insight into what impact COVID-19 has had on the international scientific community, their work and the implications for science, we conducted a survey with our editors, reviewers and authors in May and June 2020. In one of the largest academic surveys ever conducted, 25,307 members of our academic community participated, representing diverse countries, roles, and areas of research
1. Despite the massive disruption, researchers’ day to day work has not been significantly affected by COVID-19 at the time of the survey, with many able to continue their professional role throughout.
2. Many researchers expressed that policy makers had not sufficiently taken scientific advice into account to mitigate the pandemic.
3. Nearly half of the researchers surveyed fear that the pandemic will have a long-lasting effect on funding.
4. Researchers ask that policy makers invest more funding into basic research, and better ways for science to advise policy and decision making.
5. The pandemic has encouraged many to reconsider how they share their work with researchers more likely to publish open access, share their data and use preprint servers.
6. Most researchers want to contribute to task forces, primarily with research into the virus itself or through interdisciplinary knowledge-sharing.
7. There is concern about future pandemics, but researchers are equally concerned about climate change, which we can prepare for and mitigate with the help of science.
8. Researchers stress the importance of learning from the COVID-19 pandemic, allowing us to become more resilient in the future.

43. International: The Independent: Video: Covid nurse death toll now as high as the number of nurses who died during World War One
As many nurses have now died from coronavirus than were killed during the entirety of the First World War, the International Council of Nurses (ICN) has revealed.
The latest figures collated by the federation of 130 national nurses’ associations show that 1,500 nurses have lost their lives since the pandemic began around the world.
This is the same as the number of nurses believed to have been killed during the four years of World War One.
However, the ICN expects the figure of 1,500 to be a significant underestimate, as it only includes those who have died in 44 countries where data was available.
“The fact that as many nurses have died during this pandemic as died during World War I is shocking”, the federation’s chief executive Howard Catton said during an online conference earlier this week.
“Since May 2020 we have been calling for the standardised and systematic collection of data on healthcare worker infections and deaths, and the fact that is still not happening is a scandal.”
Separate analysis of global infection rates by the ICN suggests at least 20,000 healthcare workers have died in total from Covid, although this is only an extrapolation as concrete numbers do not exist.
S ED Video

44. Sri Lanka: University of Sri Jayewardenepurs: Whole genomic sequencing of the SARS-CoV2 strains resulting in the massive outbreak in Sri Lanka in October 2020 by scientists of USJ
Sri Lanka is currently experiencing a massive outbreak, which originated in Minuwangoda, Gampaha district and is now spreading all over Sri Lanka. The scientists at the Department of Immunology and Molecular Medicine and Allergy, Immunology and Cell Biology Unit of University of Sri Jayewardenepura embarked on carrying out whole genomic sequencing of the virus, to determine to see if the current outbreak is due to spread of different strains, if there are certain mutations that result in the rapid spread of the virus and to investigate the relationship between the current circulating virus strains to previous strains circulating in Sri Lanka.
Key findings of the study are:
The current circulating strain is different to the strains that circulated previously.
It has the mutation associated with high transmissibility due to high viral loads.
The same virus strain is so far responsible for the infections detected in the Minuwangoda, Colombo Municipality area and the Fish market cluster

45. UK: The Guardian: The government’s secretive Covid contracts are heaping misery on Britain
Bypassing the NHS and handing crucial services to corporate executives has led to the catastrophic failure of test and trace. If you are not incandescent with rage, you haven’t grasped the scale of what has been done to us. The new surge in the coronavirus, and the restrictions and local lockdowns it has triggered, are caused in large part by the catastrophic failure of the test-and-trace system. Its £12bn budget has been blown, as those in charge of it have failed to drive the infection ratebelow the critical threshold. Their failure was baked in, caused by the government’s ideological commitment to the private sector. This commitment had three impacts: money that could have saved lives has been diverted into corporate profits; inexperienced consultants and executives have been appointed over the heads of qualified public servants; instead of responsive local systems, the government has created a centralised monster.


47. USA: CNN Editorial: Prestigious medical journal calls for US leadership to be voted out over Covid-19 failure
In an unprecedented move, the New England Journal of Medicine on Wednesday published an editorial written by its editors condemning the Trump administration for its response to the Covid-19 pandemic — and calling for the current leadership in the United States to be voted out of office.
“We rarely publish editorials signed by all the editors,” said Dr. Eric Rubin, editor-in-chief of the medical journal and an author of the new editorial.
The editorial, which Rubin said was drafted in August, details how the United States leads the world in Covid-19 cases and deaths. So far, more than 7.5 million people in the United States have been diagnosed with Covid-19 and more than 200,000 people have died of the disease.
“This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy,” the editorial says.US and UK are bottom of the pile in rankings of governments’ handling of coronavirus pandemic It does not endorse a candidate, but offers a scathing critique of the Trump administration’s leadership during the pandemic.

48. The Lancet: COVID-19, comics, and the visual culture of contagion
The COVID-19 pandemic is inescapable. From curtailing our daily social and professional interactions, locking down or physically distancing our communities, and drawing our anxious attention to daily updates of international case and death statistics, the lived experience of the pandemic is at once personal, local, and global. It is also a shared experience that emphasises, through the pandemic’s pervasive disruption, the social interactions and behaviours that define our shared world. One cultural response to the disruption and uncertainty during an infectious disease outbreak is the construction of what Priscilla Wald terms the “outbreak narrative”, a formulaic plot that serves to shape our collective understanding of a pandemic. This narrative traces the emergence and spread of a novel pathogen and the scientific, social, and political responses to the outbreak. In doing so, the outbreak narrative emphasises the breakdown of boundaries, the sites of infection, the social interactions that are disrupted and enacted, and the efforts of science to contain the spread and find a cure. In our increasingly visual society, images are a vital component of the outbreak narrative and more broadly contribute to the visual culture of contagion.

49. USA: Washington Post: Time to ditch ‘toxic positivity,’ experts say: ‘It’s okay not to be okay’
In the midst of a raging pandemic and widespread social unrest, these days it can feel as if reassuring platitudes are inescapable.
“Everything will be fine.” “It could be worse.” “Look on the bright side.”
But as well intentioned as those who lean on such phrases may be, experts are cautioning against going overboard with the “good vibes only” trend. Too much forced positivity is not just unhelpful, they say — it’s toxic.
“While cultivating a positive mind-set is a powerful coping mechanism, toxic positivity stems from the idea that the best or only way to cope with a bad situation is to put a positive spin on it and not dwell on the negative,” said Natalie Dattilo, a clinical health psychologist with Brigham and Women’s Hospital in Boston. “It results from our tendency to undervalue negative emotional experiences and overvalue positive ones.”
S ED Mental

50. USA: NEJM: Lessons We’ve Learned — Covid-19 and the Undocumented Latinx Community
In March 2020, when there were 30,000 confirmed Covid-19 cases in the United States, one of us wrote about the pandemic’s effects on undocumented immigrants. By August, there were about 50,000 new U.S. cases per day, and we had spent several months caring for patients with Covid-19. Today, revisiting the issues of anti-immigrant policies, limited access to care, language barriers, and the need to work elicits painful memories of the people we’ve met in the hospital and the community.
We work in Baltimore, where only 5.5% of the population is Latinx.2 However, Latinx people are the fastest-growing ethnic or racial group in the city, primarily because of migration from Mexico and Central America. As compared with the general U.S. Latinx population, Latinx people in Baltimore are more likely to be foreign-born and to have low incomes, low educational attainment, and limited English proficiency. Rapid demographic changes have long strained the city’s capacity to provide culturally and linguistically competent care, but these challenges became especially acute during the pandemic.
Before Covid-19, immigrant Latinx patients accounted for a small proportion of admissions in the Johns Hopkins Health System. On average, Latinx people in Baltimore are young (81% are under 45), and many aren’t eligible for insurance through the Affordable Care Act, so they generally avoid hospital care when possible. But by April, our inboxes were flooded with email messages from colleagues alarmed by the number of Spanish-speaking patients with Covid-19 in our system.

Best wishes to you all and stay safe
John Wynn-Jones