Immunisations photos on Flickr

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Accompagner la mort des autres ne m’a pas immunisée contre l’appréhension de la croiser. Je me méfie de tous ceux qui disent que mourir s’apprend et qu’il existerait une méthode imparable pour se résoudre à l’accepter.

Vivre avec nos morts - Delphine Horvilleur

Flower seller by Ρούνες Λιου

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118 N. Maoming Rd., Shanghai

This photo was taken on 20 November 2022, before the protests broke out, before sporadic lockdowns were in place all over the city under the regular zero-Covid policy, and while urban life maintained a superficial calm. No one could have imagined that half a month later the Chinese government would, unprepared, suddenly drop all restrictions in a malicious manner to artificially encourage mass contagion in an attempt to achieve the goal of immunisation of the population within two or three months - even though it might not actually be achieved.

Lilies in morning sunlight by Mr Joel's Photography

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I photographed the flowers on our North-facing window ledge with my Fujifilm X-T3 camera.

Software used:

Capture One Fujifilm Express for RAR conversion to a Tiff.

Lightroom 5

Photoshop Elements 11 for re-sizing and adding my logo.

I haven't taken many photos so far with this camera, which I bought nearly-new from eBay, shortly before Covid 19 lockdown. I'm looking forward to the time when this nightmare is over, following mass immunisation of everyone. :-)

Dans le secteur des herpestidés @Biotropica by Philippe HELLOIN

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. Les herpestidés constituent une famille de carnivores féliformes et comportent des espèces comme les mangoustes et les suricates(clichés demain)

Les herpestidés ont une face et un corps allongés, des oreilles petites et rondes, des pattes courtes et une queue longue et effilée. La plupart sont tachetées ou grisonnantes ; un petit nombre a une fourrure bien marquée. Leurs griffes ne sont pas rétractiles et elles les utilisent surtout pour creuser la terre.

Moins diversifiées que les viverridés, cette sous-famille regroupe une trentaine d'espèces africaines et asiatiques vivant dans des habitats divers qui vont des forêts ouvertes aux savanes, aux régions semi-arides et aux déserts. Elles sont principalement terrestres, mais quelques-unes sont aquatiques ou semi-arboricoles.

Certaines mangoustes sont immunisées contre les toxines de beaucoup de serpents .......

A la fois prédateur et prédaté, la mangouste naine est une acteur complexe de la chaine alimentaire.

Comme beaucoup de prédateurs, elle peut être dévorée à son tour par des rapaces ou d’autres prédateurs affamés.

Les mangoustes naines et certains calaos entretiennent d’excellentes relations.

Pendant que les mangoustes chassent, les calaos les alertent en cas de danger.

En retour, les calaos se régalent des petites proies débusquées par les mangoustes lors de leurs actives recherches d’insectes;

Poids 300 g taille 30 cm se nourrit de insectes, œufs, petits vertébrés est dépendant(e) de la mère > 2 mois

vit en Afrique où elle est abondante

Je suis incertain quant à l'identification de ce cliché , en comparant avec les mangoustes que j'ai pu cotoyer en Afrique ( elles sont vite familières et très curieuses de tout)qui étaient des mangoustes à rayures.

Je pense d'avantage à un suricate comme le suggère Raymonde...voir ressemblance avec clichés de demain

Cuckoo by Tim Melling

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Cuckoos are the shortest staying summer migrants, arriving in April, with most adult birds disappearing in July. The reason for this is because they don't have to hang around rearing their chicks as female Cuckoos lay their eggs in other birds' nests leaving the parasitised hosts to do all of the incubation and chick-rearing. But worse than that, the young Cuckoo turfs out any step siblings from the nest to ensure it gets the undivided attention of the unwitting foster parents. And as for the father Cuckoo, well mating is about his only contribution to the process. Incidentally, it was Edward Jenner who first reported that newly-hatched Cuckoos ejected any unhatched eggs or young chicks from the nest in 1788. It was Jenner who eight years later discovered vaccination against the deadly disease Smallpox by using serum from Cowpox victims. Cowpox was a milder, non-lethal disease that helped the body build up an immunity against the deadly Smallpox. Anyway, back to Cuckoos, most people believed it was the parent Cuckoos that removed the nest contents, probably because the female Cuckoo removes one egg from the host immediately prior to laying her own. But Jenner noticed that young Cuckoos had a depression in their backs that was used to heave eggs (or young chicks) out of the nest. Jenner received ridicule at the time from the likes of Charles Waterton, and the idea remained contentious for more than a hundred years. It was only really put to bed in the twentieth century when Eric Hosking photographed a young Cuckoo in the act of ejecting eggs. And just one final thought on Edward Jenner, a hero of medicine, possibly saving more lives than any other man because he was right with his hunch about immunisation. But just imagine if he'd got it wrong. He took a healthy child, injected him with serum from a blister of someone suffering from Cowpox, then exposed this previously healthy child to the deadly Smallpox.

I took this Cuckoo yesterday morning in the Peak District.

246. Killing time by In Memoriam: Eiona R

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This should have been Save the Date until I realised that I’d chosen a watch which doesn’t have a date on it. However thanks to the Welsh Govt’s immunisation rollout, I’ll be going for my Covid Autumn Booster Covid Vacc later on…

gov.wales/autumn-booster-invitations-issued-eligible-adul...

TTT #5... 259365 by palo

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Tiny Travel Tip #5

If traveling abroad check to see if you need any vaccinations ... even if you don't like needles ... and take out medical insurance .. making sure you advise the company of any existing health problems otherwise you may not be covered in the event of an illness abroad.

... but Palo what about rabies, malaria, tetanus, cholera, yellow fever, diphtheria ... and there's a million more ...

- well Tiny you don't need to get a needle for all those things just because you are traveling it depends on where we are going ...

... phew

259/365 Toy Project

259/365 One Object 365 Project

27 December 2020: Pfizer BioNTech vaccine arrived in all European countries. by RudyMareelPhotography

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27 December 2020: Update on The Corona Pandemic – There’s been a 6% drop in the average daily number of confirmed coronavirus cases in the week to 22 December with 2,378 cases being recorded each day on average. Also, the number of hospitalisations and deaths has fallen. Yesterday, a first batch of 10,000 vaccines from Pfizer/BioNTech arrived at the University Hospital of Leuven. The hospital will serve as the central hub for distribution of the vaccine across Belgium. Supplies for all of Europe will be furnished from the Pfizer factory in Puurs, Belgium. The rest of the world is supplied by the company’s main plant in Kalamazoo, Michigan. The Belgian government provided yesterday also more details on the roll-out of its vaccination strategy. Care home residents will be vaccinated first. The roll-out of the vaccine to all care homes could take until the end of February. Starting March hospital staff and first line care workers will be immunised. As of May, people over 65 living at home and people with chronic illnesses will be vaccinated. Isn’t that two months later than what initially was announced? Anyhow, the timing of the whole operation will largely depend on the availability of vaccines. It’s unclear to me if this schedule is based on the Pfizer BioNTech vaccine only and if the current plan will be reviewed and hopefully accelerated as soon as the Moderna vaccine has received market approval in the second half of January. Whatever the timing will be there is hope… Today’s picture of somebody cycling through a cold and grey landscape northwest of Ghent depicts the long and cold winter we still have ahead of us – Meetjesland, Belgium

Smiles are highly contagious by Steve Taylor

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Remember do not get immunised today

17 May 2021: Ghent finds back its hustle and bustle now that the positive Corona news continues… by RudyMareelPhotography

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17 May 2021: The coronavirus figures continue to fall. During the week from 7 to 13 May an average of 2,267 people in Belgium tested positive for coronavirus each day. This is down 24% on the average for the previous week. There are currently 1,813 patients with COVID-19 being cared for in Belgian hospitals, a fall of 16% on the figures from a week ago. Of those in hospital, 622 are on intensive care wards. The positivity rate is 6% and the reproduction number stands at 0.91. On Friday 14 May 3,851,216 people had already received their first dose of coronavirus vaccine. This is 41.9% of the adult population. Of these 1,277,779 are fully immunised against coronavirus. The Flemish Health Minister announced yesterday that he expects that the vaccination campaign in Flanders will have been completed by mid-August. By then everyone that wishes to be vaccinated will have been given the necessary two vaccine doses (or single dose if the Johnson and Johnson vaccine is used). He added that he also aims to offer all 16- and 17-year-olds in Flanders a coronavirus vaccine by 11 July. Ghent finds back its hustle and bustle now that the positive Corona news continues… - Ghent, Belgium

12 June 2021: We are emerging out of the darkness into the light… by RudyMareelPhotography

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12 June 2021: A recent study carried out by Sciensano, the Belgian public health institute, has found that the coronavirus vaccines are proving highly effective. The study found that no more that 3 out of every 1,000 people that had already been fully immunised became infected with the coronavirus. Moreover, of these 2 out 3 showed no symptoms. There is more good news… From Wednesday, 16 June Belgium, as one of the first European countries, will start issuing the European Digital COVID Certificate. It will be issued to people that have been fully immunised for at least two weeks, have had and recovered from coronavirus within the past 6 months or have had a PCR test and tested negative for coronavirus prior to their departure. The only worrying news is that whilst the British variant is still dominant in Belgium, the more infectious Indian variant (delta variant) is gaining ground. Last week it accounted for 1.3% of all infections, this is 3.9% this week. Meanwhile, the corona figures continue to fall sharply. There are currently 820 COVID-19 patients being cared for in Belgian hospitals; of those hospitalised 302 are on intensive care wards. During the week from 2 to 8 June an average of 1,078 people in Belgium tested positive for the coronavirus. This is 37% down on the figures from the previous week. The positivity rate dropped to 3.3 and the reproductive rate fell to 0.83. Finally, it looks like we are emerging out of the darkness into the light… Tweebruggenstraat, Ghent, Belgium.

6 June 2021: Whilst I’m awaiting my second jab I continue to document Ghent’s streetart… by RudyMareelPhotography

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There have been mixed reactions to yesterday’s announcements by the government of the changes to the coronavirus regulation which consisted generally of a lifting of restrictions. Whilst the hospitality and travel industry welcomed the decisions, healthcare professionals expressed concerns that too many measures are relaxed at the same time and that there is a chance that the relaxations are going too fast compared to the number of vaccinations. Their main concern is a potential surge of the Delta variant, formerly known as the India variant. They are basically okay with the things that are allowed in open air but are finding indoor activities too risky and are hoping that people will remain careful. Otherwise, they are afraid we will see an increase again from the end of June, which is predicted by the statisticians. Meanwhile, the number of people with the virus that are being hospitalised continues to fall. There are currently 1,007 COVID-19 patients being cared for in Belgian hospitals; of those hospitalised 341 are on intensive care wards. During the week from 27 to 2 June an average of 1,578 people in Belgium tested positive for the coronavirus. This is 15% down on the figures for the previous week. The positivity rate remains at 0.44 and the reproductive rate is slightly up to 0.87. On Thursday 3 June (the latest date for which figures are available) 4,882,939 had been given their first dose of coronavirus vaccine. This is 53% of the adult population. Of these 2,351,884 are fully immunised. On display today is another mural from Dok Noord – Ghent, Belgium.

Face of 2020 by Rashmi

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The face of 2020 will haunt us for a long time to come. We were true to these times of fear and courage, despair and hope, helplessness and help. But above all it has been a time when we had nothing to prove but fidelity to the spirit of holding on. Kipling could not have been more proud.

“If you can make one heap of all your winnings

And risk it on one turn of pitch-and-toss,

And lose, and start again at your beginnings

And never breathe a word about your loss;

If you can force your heart and nerve and sinew

To serve your turn long after they are gone,

And so hold on when there is nothing in you

Except the Will which says to them: ‘Hold on!’

As the priority of privileges goes, she and her family may be a long way from getting immunised. But then may be as nature’s priorities go, they may develop herd immunity sooner than science comes to their rescue.

I have seen several such faces, some of them I have shared on Flickr. I am thankful to you for showing support, encouragement and hope.

I have received heart warming responses to my rather scattered gallery of nature and birds and streets.

Fabulous work from Francesc Candel, www.flickr.com/photos/141453264@N07/, Pascal Reiemann, www.flickr.com/photos/95566715@N08/, Nancy Charlton , www.flickr.com/photos/32927502@N07/, has kept me inspired. If it was not for the generosity and kindness of @Leon Van Kemenade, @Jeanne @Paul Gallagher @RavenXXIII @Jean-Marc Depreux Raven, @Laszlo Bacs @James R. Page, @ Eduardo Vales, @robert moushi I would have been but a dull photographer. Your own work is so wonderful, I have learnt many a line and light from you.

With hope in my heart and a little mist in my eyes, my heart-felt thanks to all of you my dear Flickr friends for showing me how to hold on!

A Distraction by Grantmasters

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Something completely different for my photostream.

Acquired immunity - the only way to be sure.

Emilie ... by Hélio Phil

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Emilie ,ma raison de vivre , a strictement respecté le confinement , elle n'est sortie qu'une seule foi pour faire ses courses il y a deux semaines...

Bien sûr , comme tout Français de base (ceux qui ne sont rien...) , elle n'avait ni masque , ni gel ...

Et malgré un maximum de précautions (elle est tout de même prof de microbiologie...) , elle a été contaminée ...

Elle est maintenant en phase descendante de la maladie , et grâce à sa jeunesse , sa vie saine ( ni tabac ni alcool ), aucun surpoids vu qu'elle est une grande sportive , tout s'est passé en confinement , pas d'hôpital...

Elle va donc , en théorie , se trouver en position idéale , puisqu'elle devrait être immunisée contre le Covid 19... (mais il semblerait qu'il mute déjà...)

La cage qui enserrait ma poitrine se desserre progressivement...

Injecting some reality 15/30 by Ralph Rayner

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Off to be Covid-19 immunised today. It took a while as there were a lot of people queueing to go through the cattle sheds. The irony! I feel much better now that the nanobots are working with the 5G signal.

Must D-E-S-T-R-O...... oh no!

dans le domaine des mangoustes by Philippe HELLOIN

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. Les herpestidés constituent une famille de carnivores féliformes et comportent des espèces comme les mangoustes et les suricates(clichés demain). Ces deux espèces sont présentes à Biotropica ....

Certaines mangoustes sont immunisées contre les toxines de beaucoup de serpents .......

A la fois prédateur et prédaté, la mangouste naine est une acteur complexe de la chaine alimentaire.

Comme beaucoup de prédateurs, elle peut être dévorée à son tour par des rapaces ou d’autres prédateurs affamés.

Ce cliché remplace (un précédent de Biotropica mal identifié )par un cliché des nombreuses mangoustes qui tentaient de visiter nos tentes en Afrique ( elles sont vite familières et très curieuses de tout)

Merci Raymonde d'avoir attiré mon attention..

Doggie Immunisations coming up by Christine

Daily Dog Challenge: Protection

Kahn & Etta are waiting for the Vet to give them their Kennel Cough Immunisation squirt up the nose. They don't mind because they get a treat along with it :)

Flu Shots for Pregnant Mothers by aka Gerald

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Promotion pamphlet, Immunise Australia Program.

Sydney

Clive's vegetable garden cake ~ stressful for all the wrong reasons! ^**^ by the-icing-on-the-cake. (Jo)

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This cake was for Clive's surprise 60th birthday party! - Here he is in his rather well tended to vegetable garden!

I was getting rather stressed making this cake! - I very nearly decided to deliver a plain white cake and in true 'the Emperor’s clothes style' say it WAS a garden... but it snowed!.

I was stressed - not least because as I prepared to decorate it my husband decided that now was the time to give the cat his worming pill! - Great sense of timing husbands have! - So, me being a nurse!?! was asked to help! - I mean yes, I do give 4 year olds their pre-school booster immunisations, but hey, 4 year olds don't have teeth and claws! (well most don't!).

4 year olds cannot give you the look of sheer horror as they are held tightly with a chunky finger of DH being rammed down their throat either!

I could feel my blood pressure rising and almost steam coming out of my ears by the time we retreaved the pill from the floor for the 3rd time, so I gave up and let the cat go.

I mashed the now very sticky tablet into a paste and hid it in some cooked chicken chunks.

I sat and hand fed some unadulterated chicken to the somewhat terrified cat whilst sat under the dining room table with him. Just as I thought I had lulled him into a false sense of security I made a bid for completion of 'operation worm' by handing him the poison chalice! - yes the piece of chicken laced with no doubt some foul tasting anti-worm medication.

Well, I was spotted - it was unceremoniously spat back at me ... undaunted I offered another piece of chicken, a nice one this time.... and what did I get for my trouble?! - a side swipe from a front paw -and an 'if you think I'm taking poisoned poultry from you, you can think again' look.

Undeterred I offered another piece of chicken - and got side swiped again - bearing in mind I'm still sat under the dining table with the cat!....

... I decide to make a cup of tea and call in reinforcements....

DH comes back in ... I head upstairs to get the secret weapon...

.... My cat (Beaker) has always been fascinated with bags and boxes only marginally big enough to house him ... so I knew he wouldn't resist getting into an empty rucksack.... 3,2,1.... Yep he got in.

I zipped it up.

It wriggled A LOT!. (I wondered if the saying you have to be cruel to be kind was coined for this very occasion…)

I unzipped it slightly until a head popped though the opening.

I zipped it shut again! - so just a head stuck out! - I glanced at my DH - by now we had both seen the funny side of our predicament and casting hilarity aside got on with the job in hand...

Ah-ha - we now had a rucksack, albeit a squirming rucksack, this one has teeth but no claws!.

I took the top jaw, DH took the bottom jaw, and we opened inserted tablet and most of DH's fist! - and hurrah! - tablet was delivered!! ....

... At least we think it was. I will no doubt find it in days to come somewhere in the lounge…

… Never again will I look upon a parent with scorn as they attempt to hold their squirming 4 year old still for me to stick a needle in its arm!.

Beaker is going to the vets for his next worming tablet! … no amount of nursing qualifications will tempt me to try the impossible again!

(anyone noticing the writing style will know I am the biggest fan of Deric Longden!!) LOL!

Return To Innocence II by Ragstatic

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Explored #221. Thank You

Needed some sanity check ! after all the Blending & HDR work, decided to have an immunisation shot :-) . Portraits are not exactly my forte....will soon be heading into "performances/arts photography"

This was shot at Hmong Tribal Village , Chiang Mai, Thailand. She did'nt pose. No Flash. The light was low as she was in a sheltered area.

Hopefully after a couple of single expousres, will be back with some regular programming ;-)

Where's our vaccine??? Wo ist unser Impfstoff??? by Bonzo Din

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Amid discussions about production shortfalls and shortages of vaccine - and possible tricky dealings - Mrs Din and I were mildly surprised on a recent "corona" walk in our neighbourhood to find this building large as life looking down upon us.

The inscription (in majestic majuscules) reads:

"INSTITUTION FOR THE PRODUCTION OF VACCINES."

Well, there you have it!!! And where are the goods??? Who needs Biontech, Moderna, Astra Zeneca and whatever they may call themselves? We, here in little old working-class Ottakring, on the outskirts of Vienna and of the Western World, have our own Royal Imperial vaccine production!!!

Yes, "majestic" is the word! The building dates from the days of the Austro-Hungarian Empire, and the Emperor's Coat of Arms (the double-headed eagle looking east and west) graces the entrance. How long it has been since vaccines were actually produced here, I don't know, but apparently there are older people around and about who can remember being vaccinated here as children. Tuberculosis ("the Viennese Disease") was a major problem in the city well into the twentieth century. This however was fought not only with vaccine, but with Vienna's exemplary community housing projects of the 1920s and the accompanying social services, hygienic measures, medical care, education etc., which resulted from the wise planning of Vienna's Socialist City Council , known as "Das Rote Wien" (Red Vienna).

Currently the building houses the "A.G.E.S." - an institute which oversees the pharmaceutical market in Austria. One of their current responsibilities is to collect data on the spread of Covid-19 and to provide statistics to the government.

Ronyi the Reclined. by Paul Smith

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Our handsome (but extremely naughty) cat Ronyi in our garden at Villa Taman Damai (Ubud, Bali).

Ronyi was taken in as a kitten after being found meowing in trash at the side of the road. He was taken in only a few weeks after our previous cat Boddah was sadly killed by a motorist.

Ronyi has been sterilised and immunised, something that does not occur often enough in Bali and we hope that our neighbours will follow our lead.

Spring on the way by buckaroo kid

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So we've been in lockdown now, with a couple of breaks, for the best part of a year. This morning i was just vaccine -d. Who knows what's next, but at least these daffs remind me that Spring might be on its way at last.

Post-immunisation by Haris Abdul Rahman

cof

Fée visiteuse by Françoise

Vous croyez aux fées?

Avec Maïa nous en avons trouvé plusieurs dans l'appartement. Dont celle-ci qui est venue nous rendre visite.

Si si...les fées sont immunisées contre les virus humains, donc aucun danger.

Celle-ci était venue me porter un message-question d'ami, qu'elle avait récupéré la nuit dernière sur une plume de tourterelle. Et ce message me disait:

A ton avis, qui a suspendu la lune?

Le genre de devinette pas facile du tout...Alors, dans ma grande ignorance, j'ai interrogé le livre Les fées et j'ai découvert, tenez-vous bien, que c'était le tout premier marchand de sable qui s'était chargé de l'opération. L'ancêtre de Gregor, quoi!

Et vous savez pourquoi il l'a suspendue?

Pour permettre à tous et à toutes de l'admirer et de profiter de ses bienfaits. Sinon, il se serait toujours trouvé un humain pour prétendre qu'il en était le seul propriétaire. Malin, le marchand de sable!

J'ai donc glissé ma réponse sur plusieurs plumes et duvets, confié le tout à la fée...J'ose espérer que mon message parviendra sans encombre à destination.

La lune, elle est utile à tous pour les marées, les changements de saison, le jardinage, et même pour couper les arbres.

Si...c'est Joseph qui nous le dit. Et il sait de quoi il cause:

www.youtube.com/watch?v=70vv3SpOEyo

Post-immunisation by Haris Abdul Rahman

Blogged here.

Schluckimpfung / Oral vaccination by rudi_valtiner

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Das Weingut Lenikus aus Grinzing, einem Weinbauort in Wien, hatte einen besonders originellen und lustigen Zugang zum Thema Impfung. Offenbar erinnerten sie sich an den "lieben Augustin", der die Pestzeit in Wien selbst in der hochinfektiösen Pestgrube mit all den Pest-Toten angeblich deswegen gesund überstand, weil er durch seine starke Alkoholisierung eine Art Immunisierung erreichte. Aus dieser besonderen Form einer Impfung machte das Weingut zwei verkaufsfördernde Weinbezeichnungen: Schluckimpfung und Wiener Jaukerl (wie der Wiener zu einer gespritzten Impfung sagt). Finde ich lustig ! Gesehen in Wien-Grinzing.

The Lenikus winery from Grinzing, a wine-growing village in Vienna, had a particularly original and funny approach to the subject of vaccination. Apparently they remembered the "dear Augustin", who supposedly survived the plague period in Vienna healthy even in the highly infectious plague pit with all the plague dead because he achieved a kind of immunisation through his strong alcoholisation. The winery made two sales-promoting wine names out of this special form of inoculation: Schluckimpfung and Wiener Jaukerl (Oral vaccination and Viennese Jaukerl, as the Viennese say to an injected vaccination). I find that funny ! Seen in Vienna-Grinzing.

virus by Lars Schleicher

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by traceytakesphotos

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Jovie had her 8 week immunisation's today and was weighed and measured.. Girl is a little tank just like her brother!

Weight - 5.78kgs

Length - 58cms

+ 2 shots

And she ain't happy LOL

Coronavirus disease 2019...Passive antibodies... immune systems... antibody-dependent cellular cytotoxicity...Sex differences...Gendered impact of the pandemic and mortality rates are different for men and women. by Hughes Songe

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[8] The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic.[9][10] As of 26 April 2020, more than 2.89 million cases have been reported across 185 countries and territories, resulting in more than 203,000 deaths. More than 822,000 people have recovered.[7]

Common symptoms include fever, cough, fatigue, shortness of breath and loss of smell.[5][11][12] While the majority of cases result in mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm.[13][9][14] More concerning symptoms include difficulty breathing, persistent chest pain, confusion, difficulty waking, and bluish skin.[5] The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days.[5][15]

The virus is primarily spread between people during close contact,[a] often via small droplets produced by coughing,[b] sneezing, or talking.[6][16][18] The droplets usually fall to the ground or onto surfaces rather than remaining in the air over long distances.[6][19][20] People may also become infected by touching a contaminated surface and then touching their face.[6][16] In experimental settings, the virus may survive on surfaces for up to 72 hours.[21][22][23] It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.[24] The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.[25] Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using it for routine screening.[26][27]

Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), covering coughs, and keeping unwashed hands away from the face.[28][29] In addition, the use of a face covering is recommended for those who suspect they have the virus and their caregivers.[30][31] Recommendations for face covering use by the general public vary, with some authorities recommending against their use, some recommending their use, and others requiring their use.[32][31][33] Currently, there is not enough evidence for or against the use of masks (medical or other) in healthy individuals in the wider community.[6] Also masks purchased by the public may impact availability for health care providers.

Currently, there is no vaccine or specific antiviral treatment for COVID-19.[6] Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.[34] The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC)[35][36] on 30 January 2020 and a pandemic on 11 March 2020.[10] Local transmission of the disease has occurred in most countries across all six WHO regions.[37]

File:En.Wikipedia-VideoWiki-Coronavirus disease 2019.webm

Video summary (script)

Contents

1Signs and symptoms

2Cause

2.1Transmission

2.2Virology

3Pathophysiology

3.1Immunopathology

4Diagnosis

4.1Pathology

5Prevention

6Management

6.1Medications

6.2Protective equipment

6.3Mechanical ventilation

6.4Acute respiratory distress syndrome

6.5Experimental treatment

6.6Information technology

6.7Psychological support

7Prognosis

7.1Reinfection

8History

9Epidemiology

9.1Infection fatality rate

9.2Sex differences

10Society and culture

10.1Name

10.2Misinformation

10.3Protests

11Other animals

12Research

12.1Vaccine

12.2Medications

12.3Anti-cytokine storm

12.4Passive antibodies

13See also

14Notes

15References

16External links

16.1Health agencies

16.2Directories

16.3Medical journals

Signs and symptoms

Symptom[4]Range

Fever83–99%

Cough59–82%

Loss of Appetite40–84%

Fatigue44–70%

Shortness of breath31–40%

Coughing up sputum28–33%

Loss of smell15[38] to 30%[12][39]

Muscle aches and pains11–35%

Fever is the most common symptom, although some older people and those with other health problems experience fever later in the disease.[4][40] In one study, 44% of people had fever when they presented to the hospital, while 89% went on to develop fever at some point during their hospitalization.[4][41]

Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains.[4][5][42][43] Symptoms such as nausea, vomiting and diarrhoea have been observed in varying percentages.[44][45][46] Less common symptoms include sneezing, runny nose, or sore throat.[47]

More serious symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking, and bluish face or lips. Immediate medical attention is advised if these symptoms are present.[5][48]

In some, the disease may progress to pneumonia, multi-organ failure, and death.[9][14] In those who develop severe symptoms, time from symptom onset to needing mechanical ventilation is typically eight days.[4] Some cases in China initially presented with only chest tightness and palpitations.[49]

Loss of smell was identified as a common symptom of COVID‑19 in March 2020,[12][39] although perhaps not as common as initially reported.[38] A decreased sense of smell and/or disturbances in taste have also been reported.[50] Estimates for loss of smell range from 15%[38] to 30%.[12][39]

As is common with infections, there is a delay between the moment a person is first infected and the time he or she develops symptoms. This is called the incubation period. The incubation period for COVID‑19 is typically five to six days but may range from two to 14 days,[51][52] although 97.5% of people who develop symptoms will do so within 11.5 days of infection.[53]

A minority of cases do not develop noticeable symptoms at any point in time.[54][55] These asymptomatic carriers tend not to get tested, and their role in transmission is not yet fully known.[56][57] However, preliminary evidence suggests they may contribute to the spread of the disease.[58][59] In March 2020, the Korea Centers for Disease Control and Prevention (KCDC) reported that 20% of confirmed cases remained asymptomatic during their hospital stay.[59][60]

A number of neurological symptoms has been reported including seizures, stroke, encephalitis and Guillain-Barre syndrome.[61] Cardiovascular related complications may include heart failure, irregular electrical activity, blood clots, and heart inflammation.[62]

Cause

See also: Severe acute respiratory syndrome coronavirus 2

Transmission

Cough/sneeze droplets visualised in dark background using Tyndall scattering

Respiratory droplets produced when a man is sneezing visualised using Tyndall scattering

File:COVID19 in numbers- R0, the case fatality rate and why we need to flatten the curve.webm

A video discussing the basic reproduction number and case fatality rate in the context of the pandemic

Some details about how the disease is spread are still being determined.[16][18] The WHO and the U.S. Centers for Disease Control and Prevention (CDC) say it is primarily spread during close contact and by small droplets produced when people cough, sneeze or talk;[6][16] with close contact being within approximately 1–2 m (3–7 ft).[6][63] Both sputum and saliva can carry large viral loads.[64] Loud talking releases more droplets than normal talking.[65] A study in Singapore found that an uncovered cough can lead to droplets travelling up to 4.5 metres (15 feet).[66] An article published in March 2020 argued that advice on droplet distance might be based on 1930s research which ignored the effects of warm moist exhaled air surrounding the droplets and that an uncovered cough or sneeze can travel up to 8.2 metres (27 feet).[17]

Respiratory droplets may also be produced while breathing out, including when talking. Though the virus is not generally airborne,[6][67] the National Academy of Sciences has suggested that bioaerosol transmission may be possible.[68] In one study cited, air collectors positioned in the hallway outside of people's rooms yielded samples positive for viral RNA but finding infectious virus has proven elusive.[68] The droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.[16] Some medical procedures such as intubation and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be aerosolised and thus result in an airborne spread.[67] Initial studies suggested a doubling time of the number of infected persons of 6–7 days and a basic reproduction number (R0 ) of 2.2–2.7, but a study published on April 7, 2020, calculated a much higher median R0 value of 5.7 in Wuhan.[69]

It may also spread when one touches a contaminated surface, known as fomite transmission, and then touches one's eyes, nose or mouth.[6] While there are concerns it may spread via faeces, this risk is believed to be low.[6][16]

The virus is most contagious when people are symptomatic; though spread is may be possible before symptoms emerge and from those who never develop symptoms.[6][70] A portion of individuals with coronavirus lack symptoms.[71] The European Centre for Disease Prevention and Control (ECDC) says while it is not entirely clear how easily the disease spreads, one person generally infects two or three others.[18]

The virus survives for hours to days on surfaces.[6][18] Specifically, the virus was found to be detectable for one day on cardboard, for up to three days on plastic (polypropylene) and stainless steel (AISI 304), and for up to four hours on 99% copper.[21][23] This, however, varies depending on the humidity and temperature.[72][73] Surfaces may be decontaminated with many solutions (with one minute of exposure to the product achieving a 4 or more log reduction (99.99% reduction)), including 78–95% ethanol (alcohol used in spirits), 70–100% 2-propanol (isopropyl alcohol), the combination of 45% 2-propanol with 30% 1-propanol, 0.21% sodium hypochlorite (bleach), 0.5% hydrogen peroxide, or 0.23–7.5% povidone-iodine. Soap and detergent are also effective if correctly used; soap products degrade the virus' fatty protective layer, deactivating it, as well as freeing them from the skin and other surfaces.[74] Other solutions, such as benzalkonium chloride and chlorhexidine gluconate (a surgical disinfectant), are less effective.[75]

In a Hong Kong study, saliva samples were taken a median of two days after the start of hospitalization. In five of six patients, the first sample showed the highest viral load, and the sixth patient showed the highest viral load on the second day tested.[64]

Virology

Main article: Severe acute respiratory syndrome coronavirus 2

Illustration of SARSr-CoV virion

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[76] All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature.[77] Outside the human body, the virus is killed by household soap, which bursts its protective bubble.[26]

SARS-CoV-2 is closely related to the original SARS-CoV.[78] It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13).[47] In February 2020, Chinese researchers found that there is only one amino acid difference in the binding domain of the S protein between the coronaviruses from pangolins and those from humans; however, whole-genome comparison to date found that at most 92% of genetic material was shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host.[79]

Pathophysiology

The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell.[80] The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested that decreasing ACE2 activity might be protective,[81][82] though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective and these hypotheses need to be tested.[83] As the alveolar disease progresses, respiratory failure might develop and death may follow.[82]

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium[84] as well as endothelial cells and enterocytes of the small intestine.[85]

ACE2 is present in the brain, and there is growing evidence of neurological manifestations in people with COVID‑19. It is not certain if the virus can directly infect the brain by crossing the barriers that separate the circulation of the brain and the general circulation. Other coronaviruses are able to infect the brain via a synaptic route to the respiratory centre in the medulla, through mechanoreceptors like pulmonary stretch receptors and chemoreceptors (primarily central chemoreceptors) within the lungs.[medical citation needed] It is possible that dysfunction within the respiratory centre further worsens the ARDS seen in COVID‑19 patients. Common neurological presentations include a loss of smell, headaches, nausea, and vomiting. Encephalopathy has been noted to occur in some patients (and confirmed with imaging), with some reports of detection of the virus after cerebrospinal fluid assays although the presence of oligoclonal bands seems to be a common denominator in these patients.[86]

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.[87] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,[88] and is more frequent in severe disease.[89] Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.[87] ACE2 receptors are highly expressed in the heart and are involved in heart function.[87][90] A high incidence of thrombosis (31%) and venous thromboembolism (25%) have been found in ICU patients with COVID‑19 infections and may be related to poor prognosis.[91][92] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside with the presentation of viral pneumonia.[93]

Another common cause of death is complications related to the kidneys[93]—SARS-CoV-2 directly infects kidney cells, as confirmed in post-mortem studies. Acute kidney injury is a common complication and cause of death; this is more significant in patients with already compromised kidney function, especially in people with pre-existing chronic conditions such as hypertension and diabetes which specifically cause nephropathy in the long run.[94]

Autopsies of people who died of COVID‑19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung.[95]

Immunopathology

Although SARS-COV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.[96]

Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.[97]

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients.[98] Lymphocytic infiltrates have also been reported at autopsy.[95]

Diagnosis

Main article: COVID-19 testing

Demonstration of a nasopharyngeal swab for COVID-19 testing

CDC rRT-PCR test kit for COVID-19[99]

The WHO has published several testing protocols for the disease.[100] The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).[101] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used.[25][102] Results are generally available within a few hours to two days.[103][104] Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value.[105] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop polymerase chain reaction (PCR) tests to detect infection by the virus.[9][106][107] As of 4 April 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development, but not yet widely used.[108][109][110] The Chinese experience with testing has shown the accuracy is only 60 to 70%.[111] The FDA in the United States approved the first point-of-care test on 21 March 2020 for use at the end of that month.[112]

Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying people who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count.[113]

A study asked hospitalised COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers (collection at home or in the car).[64]

Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening.[26][27] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection.[26] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses.[26][114]

In late 2019, WHO assigned the emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection.[115]

Typical CT imaging findings

CT imaging of rapid progression stage

Pathology

Few data are available about microscopic lesions and the pathophysiology of COVID‑19.[116][117] The main pathological findings at autopsy are:

Macroscopy: pleurisy, pericarditis, lung consolidation and pulmonary oedema

Four types of severity of viral pneumonia can be observed:

minor pneumonia: minor serous exudation, minor fibrin exudation

mild pneumonia: pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

severe pneumonia: diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

healing pneumonia: organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL[118]

Blood: disseminated intravascular coagulation (DIC);[119] leukoerythroblastic reaction[120]

Liver: microvesicular steatosis

Prevention

See also: 2019–20 coronavirus pandemic § Prevention, flatten the curve, and workplace hazard controls for COVID-19

Progressively stronger mitigation efforts to reduce the number of active cases at any given time—known as "flattening the curve"—allows healthcare services to better manage the same volume of patients.[121][122][123] Likewise, progressively greater increases in healthcare capacity—called raising the line—such as by increasing bed count, personnel, and equipment, helps to meet increased demand.[124]

Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.[122][125]

Preventive measures to reduce the chances of infection include staying at home, avoiding crowded places, keeping distance from others, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[126][127][128] The CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available.[126] Proper hand hygiene after any cough or sneeze is encouraged.[126] The CDC has recommended the use of cloth face coverings in public settings where other social distancing measures are difficult to maintain, in part to limit transmission by asymptomatic individuals.[129] The U.S. National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside of the setting of a clinical trial.[130]

Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel, and cancelling large public gatherings.[131] Distancing guidelines also include that people stay at least 6 feet (1.8 m) apart.[132] There is no medication known to be effective at preventing COVID‑19.[133] After the implementation of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate ("Rt") of less than one, meaning the disease is in remission in those areas.[134]

As a vaccine is not expected until 2021 at the earliest,[135] a key part of managing COVID‑19 is trying to decrease the epidemic peak, known as "flattening the curve".[122] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.[122][125]

According to the WHO, the use of masks is recommended only if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.[136] For the European Centre for Disease Prevention and Control (ECDC) face masks "... could be considered especially when visiting busy closed spaces ..." but "... only as a complementary measure ..."[137] Several countries have recommended that healthy individuals wear face masks or cloth face coverings (like scarves or bandanas) at least in certain public settings, including China,[138] Hong Kong,[139] Spain,[140] Italy (Lombardy region),[141] and the United States.[129]

Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.[30][142] The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. It further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.[126]

For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.[143]

Prevention efforts are multiplicative, with effects far beyond that of a single spread. Each avoided case leads to more avoided cases down the line, which in turn can stop the outbreak in its tracks.

File:COVID19 W ENG.ogv

Handwashing instructions

Management

People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs.[144][145][146] The CDC recommends that those who suspect they carry the virus wear a simple face mask.[30] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.[41][147] Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity.[148] Supportive treatments may be useful in those with mild symptoms at the early stage of infection.[149]

The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health have published recommendations for taking care of people who are hospitalised with COVID‑19.[130][150][151] Intensivists and pulmonologists in the U.S. have compiled treatment recommendations from various agencies into a free resource, the IBCC.[152][153]

Medications

See also: Coronavirus disease 2019 § Research

As of April 2020, there is no specific treatment for COVID‑19.[6][133] Research is, however, ongoing. For symptoms, some medical professionals recommend paracetamol (acetaminophen) over ibuprofen for first-line use.[154][155][156] The WHO and NIH do not oppose the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms,[130][157] and the FDA says currently there is no evidence that NSAIDs worsen COVID‑19 symptoms.[158]

While theoretical concerns have been raised about ACE inhibitors and angiotensin receptor blockers, as of 19 March 2020, these are not sufficient to justify stopping these medications.[130][159][160][161] Steroids, such as methylprednisolone, are not recommended unless the disease is complicated by acute respiratory distress syndrome.[162][163]

Medications to prevent blood clotting have been suggested for treatment,[91] and anticoagulant therapy with low molecular weight heparin appears to be associated with better outcomes in severe COVID‐19 showing signs of coagulopathy (elevated D-dimer).[164]

Protective equipment

See also: § Research

Research into potential treatments started in January 2020,[182] and several antiviral drugs are in clinical trials.[183][184] Remdesivir appears to be the most promising.[133] Although new medications may take until 2021 to develop,[185] several of the medications being tested are already approved for other uses or are already in advanced testing.[186] Antiviral medication may be tried in people with severe disease.[144] The WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.[187]

The FDA has granted temporary authorisation to convalescent plasma as an experimental treatment in cases where the person's life is seriously or immediately threatened. It has not undergone the clinical studies needed to show it is safe and effective for the disease.[188][189][190]

Information technology

See also: Contact tracing and Government by algorithm

In February 2020, China launched a mobile app to deal with the disease outbreak.[191] Users are asked to enter their name and ID number. The app can detect 'close contact' using surveillance data and therefore a potential risk of infection. Every user can also check the status of three other users. If a potential risk is detected, the app not only recommends self-quarantine, it also alerts local health officials.[192]

Big data analytics on cellphone data, facial recognition technology, mobile phone tracking, and artificial intelligence are used to track infected people and people whom they contacted in South Korea, Taiwan, and Singapore.[193][194] In March 2020, the Israeli government enabled security agencies to track mobile phone data of people supposed to have coronavirus. The measure was taken to enforce quarantine and protect those who may come into contact with infected citizens.[195] Also in March 2020, Deutsche Telekom shared aggregated phone location data with the German federal government agency, Robert Koch Institute, to research and prevent the spread of the virus.[196] Russia deployed facial recognition technology to detect quarantine breakers.[197] Italian regional health commissioner Giulio Gallera said he has been informed by mobile phone operators that "40% of people are continuing to move around anyway".[198] German government conducted a 48 hours weekend hackathon with more than 42.000 participants.[199][200] Two million people in the UK used an app developed in March 2020 by King's College London and Zoe to track people with COVID‑19 symptoms.[201] Also, the president of Estonia, Kersti Kaljulaid, made a global call for creative solutions against the spread of coronavirus.[202]

Psychological support

See also: Mental health during the 2019–20 coronavirus pandemic

Individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of the infection itself. To address these concerns, the National Health Commission of China published a national guideline for psychological crisis intervention on 27 January 2020.[203][204]

The Lancet published a 14-page call for action focusing on the UK and stated conditions were such that a range of mental health issues was likely to become more common. BBC quoted Rory O'Connor in saying, "Increased social isolation, loneliness, health anxiety, stress and an economic downturn are a perfect storm to harm people's mental health and wellbeing."[205][206]

Prognosis

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The severity of diagnosed cases in China

The severity of diagnosed COVID-19 cases in China[207]

Case fatality rates for COVID-19 by age by country.

Case fatality rates by age group:

China, as of 11 February 2020[208]

South Korea, as of 15 April 2020[209]

Spain, as of 24 April 2020[210]

Italy, as of 23 April 2020[211]

Case fatality rate depending on other health problems

Case fatality rate in China depending on other health problems. Data through 11 February 2020.[208]

Case fatality rate by country and number of cases

The number of deaths vs total cases by country and approximate case fatality rate[212]

The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[47]

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years, and 4% aged 10-19 years.[22] They are likely to have milder symptoms and a lower chance of severe disease than adults; in those younger than 50 years, the risk of death is less than 0.5%, while in those older than 70 it is more than 8%.[213][214][215] Pregnant women may be at higher risk for severe infection with COVID-19 based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.[216][217] In China, children acquired infections mainly through close contact with their parents or other family members who lived in Wuhan or had traveled there.[213]

In some people, COVID‑19 may affect the lungs causing pneumonia. In those most severely affected, COVID-19 may rapidly progress to acute respiratory distress syndrome (ARDS) causing respiratory failure, septic shock, or multi-organ failure.[218][219] Complications associated with COVID‑19 include sepsis, abnormal clotting, and damage to the heart, kidneys, and liver. Clotting abnormalities, specifically an increase in prothrombin time, have been described in 6% of those admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this group.[220] Approximately 20-30% of people who present with COVID‑19 demonstrate elevated liver enzymes (transaminases).[133] Liver injury as shown by blood markers of liver damage is frequently seen in severe cases.[221]

Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening for severe illness.[222]

Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease.[223] The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available for review, 97.2% of sampled patients had at least one comorbidity with the average patient having 2.7 diseases.[224] According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, patients transferred to an ICU had a median time of seven days between hospitalisation and death.[224] In a study of early cases, the median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days.[225] In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women had a death rate of 1.7%.[226] Histopathological examinations of post-mortem lung samples show diffuse alveolar damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were observed in the pneumocytes. The lung picture resembled acute respiratory distress syndrome (ARDS).[47] In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest.[49] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[227]

The availability of medical resources and the socioeconomics of a region may also affect mortality.[228] Estimates of the mortality from the condition vary because of those regional differences,[229] but also because of methodological difficulties. The under-counting of mild cases can cause the mortality rate to be overestimated.[230] However, the fact that deaths are the result of cases contracted in the past can mean the current mortality rate is underestimated.[231][232] Smokers were 1.4 times more likely to have severe symptoms of COVID‑19 and approximately 2.4 times more likely to require intensive care or die compared to non-smokers.[233]

Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage.[234] This may also lead to post-intensive care syndrome following recovery.[235]

Case fatality rates (%) by age and country

Age0–910–1920–2930–3940–4950–5960–6970–7980-8990+

China as of 11 February[208]0.00.20.20.20.41.33.68.014.8

Denmark as of 25 April[236]0.24.515.524.940.7

Italy as of 23 April[211]0.20.00.10.40.92.610.024.930.826.1

Netherlands as of 17 April[237]0.00.30.10.20.51.57.623.230.029.3

Portugal as of 24 April[238]0.00.00.00.00.30.62.88.516.5

S. Korea as of 15 April[209]0.00.00.00.10.20.72.59.722.2

Spain as of 24 April[210]0.30.40.30.30.61.34.413.220.320.1

Switzerland as of 25 April[239]0.90.00.00.10.00.52.710.124.0

Case fatality rates (%) by age in the United States

Age0–1920–4445–5455–6465–7475–8485+

United States as of 16 March[240]0.00.1–0.20.5–0.81.4–2.62.7–4.94.3–10.510.4–27.3

Note: The lower bound includes all cases. The upper bound excludes cases that were missing data.

Estimate of infection fatality rates and probability of severe disease course (%) by age based on cases from China[241]

0–910–1920–2930–3940–4950–5960–6970–7980+

Severe disease0.0

(0.0–0.0)0.04

(0.02–0.08)1.0

(0.62–2.1)3.4

(2.0–7.0)4.3

(2.5–8.7)8.2

(4.9–17)11

(7.0–24)17

(9.9–34)18

(11–38)

Death0.0016

(0.00016–0.025)0.0070

(0.0015–0.050)0.031

(0.014–0.092)0.084

(0.041–0.19)0.16

(0.076–0.32)0.60

(0.34–1.3)1.9

(1.1–3.9)4.3

(2.5–8.4)7.8

(3.8–13)

Total infection fatality rate is estimated to be 0.66% (0.39–1.3). Infection fatality rate is fatality per all infected individuals, regardless of whether they were diagnosed or had any symptoms. Numbers in parentheses are 95% credible intervals for the estimates.

Reinfection

As of March 2020, it was unknown if past infection provides effective and long-term immunity in people who recover from the disease.[242] Immunity is seen as likely, based on the behaviour of other coronaviruses,[243] but cases in which recovery from COVID‑19 have been followed by positive tests for coronavirus at a later date have been reported.[244][245][246][247] These cases are believed to be worsening of a lingering infection rather than re-infection.[247]

History

Main article: Timeline of the 2019–20 coronavirus pandemic

The virus is thought to be natural and has an animal origin,[77] through spillover infection.[248] The actual origin is unknown, but by December 2019 the spread of infection was almost entirely driven by human-to-human transmission.[208][249] A study of the first 41 cases of confirmed COVID‑19, published in January 2020 in The Lancet, revealed the earliest date of onset of symptoms as 1 December 2019.[250][251][252] Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019.[253] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.[254][255]

Epidemiology

Main article: 2019–20 coronavirus pandemic

Several measures are commonly used to quantify mortality.[256] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.[257]

The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 7.0% (203,044/2,899,830) as of 26 April 2020.[7] The number varies by region.[258]

Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a specific population from infection through case resolution. Many academics have attempted to calculate these numbers for specific populations.[259]

Total confirmed cases over time

Total deaths over time

Total confirmed cases of COVID‑19 per million people, 10 April 2020[260]

Total confirmed deaths due to COVID‑19 per million people, 10 April 2020[261]

Infection fatality rate

Our World in Data states that as of March 25, 2020, the infection fatality rate (IFR) cannot be accurately calculated.[262] In February, the World Health Organization estimated the IFR at 0.94%, with a confidence interval between 0.37 percent to 2.9 percent.[263] The University of Oxford Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.72 percent and IFR of 0.1 percent to 0.36 percent.[264] According to CEBM, random antibody testing in Germany suggested an IFR of 0.37 percent there.[264] Firm lower limits to local infection fatality rates were established, such as in Bergamo province, where 0.57% of the population has died, leading to a minimum IFR of 0.57% in the province. This population fatality rate (PFR) minimum increases as more people get infected and run through their disease.[265][266] Similarly, as of April 22 in the New York City area, there were 15,411 deaths confirmed from COVID-19, and 19,200 excess deaths.[267] Very recently, the first results of antibody testing have come in, but there are no valid scientific reports based on them available yet. A Bloomberg Opinion piece provides a survey.[268][269]

Sex differences

Main article: Gendered impact of the 2019–20 coronavirus pandemic

The impact of the pandemic and its mortality rate are different for men and women.[270] Mortality is higher in men in studies conducted in China and Italy.[271][272][273] The highest risk for men is in their 50s, with the gap between men and women closing only at 90.[273] In China, the death rate was 2.8 percent for men and 1.7 percent for women.[273] The exact reasons for this sex-difference are not known, but genetic and behavioural factors could be a reason.[270] Sex-based immunological differences, a lower prevalence of smoking in women, and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men.[273] In Europe, of those infected with COVID‑19, 57% were men; of those infected with COVID‑19 who also died, 72% were men.[274] As of April 2020, the U.S. government is not tracking sex-related data of COVID‑19 infections.[275] Research has shown that viral illnesses like Ebola, HIV, influenza, and SARS affect men and women differently.[275] A higher percentage of health workers, particularly nurses, are women, and they have a higher chance of being exposed to the virus.[276] School closures, lockdowns, and reduced access to healthcare following the 2019–20 coronavirus pandemic may differentially affect the genders and possibly exaggerate existing gender disparity.[270][277]

Society and culture

Name

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus",[278][279][280] with the disease sometimes called "Wuhan pneumonia".[281][282] In the past, many diseases have been named after geographical locations, such as the Spanish flu,[283] Middle East Respiratory Syndrome, and Zika virus.[284]

In January 2020, the World Health Organisation recommended 2019-nCov[285] and 2019-nCoV acute respiratory disease[286] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species or groups of people in disease and virus names to prevent social stigma.[287][288][289]

The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.[290] WHO chief Tedros Adhanom Ghebreyesus explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019).[291] The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications.[290] Both the disease and virus are commonly referred to as "coronavirus" in the media and public discourse.

Misinformation

Main article: Misinformation related to the 2019–20 coronavirus pandemic

After the initial outbreak of COVID‑19, conspiracy theories, misinformation, and disinformation emerged regarding the origin, scale, prevention, treatment, and other aspects of the disease and rapidly spread online.[292][293][294][295]

Protests

Beginning April 17, 2020, news media began reporting on a wave of demonstrations protesting against state-mandated quarantine restrictions in in Michigan, Ohio, and Kentucky.[296][297]

Other animals

Humans appear to be capable of spreading the virus to some other animals. A domestic cat in Liège, Belgium, tested positive after it started showing symptoms (diarrhoea, vomiting, shortness of breath) a week later than its owner, who was also positive.[298] Tigers at the Bronx Zoo in New York, United States, tested positive for the virus and showed symptoms of COVID‑19, including a dry cough and loss of appetite.[299]

A study on domesticated animals inoculated with the virus found that cats and ferrets appear to be "highly susceptible" to the disease, while dogs appear to be less susceptible, with lower levels of viral replication. The study failed to find evidence of viral replication in pigs, ducks, and chickens.[300]

Research

Main article: COVID-19 drug development

No medication or vaccine is approved to treat the disease.[186] International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers.[301][302] In March, the World Health Organisation initiated the "SOLIDARITY Trial" to assess the treatment effects of four existing antiviral compounds with the most promise of efficacy.[303]

Vaccine

Main article: COVID-19 vaccine

There is no available vaccine, but various agencies are actively developing vaccine candidates. Previous work on SARS-CoV is being used because both SARS-CoV and SARS-CoV-2 use the ACE2 receptor to enter human cells.[304] Three vaccination strategies are being investigated. First, researchers aim to build a whole virus vaccine. The use of such a virus, be it inactive or dead, aims to elicit a prompt immune response of the human body to a new infection with COVID‑19. A second strategy, subunit vaccines, aims to create a vaccine that sensitises the immune system to certain subunits of the virus. In the case of SARS-CoV-2, such research focuses on the S-spike protein that helps the virus intrude the ACE2 enzyme receptor. A third strategy is that of the nucleic acid vaccines (DNA or RNA vaccines, a novel technique for creating a vaccination). Experimental vaccines from any of these strategies would have to be tested for safety and efficacy.[305]

On 16 March 2020, the first clinical trial of a vaccine started with four volunteers in Seattle, United States. The vaccine contains a harmless genetic code copied from the virus that causes the disease.[306]

Antibody-dependent enhancement has been suggested as a potential challenge for vaccine development for SARS-COV-2, but this is controversial.[307]

Medications

Main article: COVID-19 drug repurposing research

At least 29 phase II–IV efficacy trials in COVID‑19 were concluded in March 2020 or scheduled to provide results in April from hospitals in China.[308][309] There are more than 300 active clinical trials underway as of April 2020.[133] Seven trials were evaluating already approved treatments, including four studies on hydroxychloroquine or chloroquine.[309] Repurposed antiviral drugs make up most of the Chinese research, with nine phase III trials on remdesivir across several countries due to report by the end of April.[308][309] Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.[309]

The COVID‑19 Clinical Research Coalition has goals to 1) facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies, 2) fast-track approvals for the candidate therapeutic compounds, 3) ensure standardised and rapid analysis of emerging efficacy and safety data and 4) facilitate sharing of clinical trial outcomes before publication.[310][311]

Several existing medications are being evaluated for the treatment of COVID‑19,[186] including remdesivir, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and lopinavir/ritonavir combined with interferon beta.[303][312] There is tentative evidence for efficacy by remdesivir, as of March 2020.[313][314] Clinical improvement was observed in patients treated with compassionate-use remdesivir.[315] Remdesivir inhibits SARS-CoV-2 in vitro.[316] Phase III clinical trials are underway in the U.S., China, and Italy.[186][308][317]

In 2020, a trial found that lopinavir/ritonavir was ineffective in the treatment of severe illness.[318] Nitazoxanide has been recommended for further in vivo study after demonstrating low concentration inhibition of SARS-CoV-2.[316]

There are mixed results as of 3 April 2020 as to the effectiveness of hydroxychloroquine as a treatment for COVID‑19, with some studies showing little or no improvement.[319][320] The studies of chloroquine and hydroxychloroquine with or without azithromycin have major limitations that have prevented the medical community from embracing these therapies without further study.[133]

Oseltamivir does not inhibit SARS-CoV-2 in vitro and has no known role in COVID‑19 treatment.[133]

Anti-cytokine storm

Cytokine release syndrome (CRS) can be a complication in the later stages of severe COVID‑19. There is preliminary evidence that hydroxychloroquine may have anti-cytokine storm properties.[321]

Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed.[322][323] It is undergoing a phase 2 non-randomised trial at the national level in Italy after showing positive results in people with severe disease.[324][325] Combined with a serum ferritin blood test to identify cytokine storms, it is meant to counter such developments, which are thought to be the cause of death in some affected people.[326][327][328] The interleukin-6 receptor antagonist was approved by the FDA to undergo a phase III clinical trial assessing the medication's impact on COVID‑19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell therapy, in 2017.[329] To date, there is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the blood-brain barrier, and exacerbating neurotoxicity while having no impact on the incidence of CRS.[330]

Lenzilumab, an anti-GM-CSF monoclonal antibody, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting T-cells in hospitalised patients with COVID‑19.[331]

The Feinstein Institute of Northwell Health announced in March a study on "a human antibody that may prevent the activity" of IL-6.[332]

Passive antibodies

Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation.[333] This strategy was tried for SARS with inconclusive results.[333] Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. Other mechanisms, however, such as antibody-dependent cellular cytotoxicity and/or phagocytosis, may be possible.[333] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.[333] Production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, could be increased for quicker deployment.[334]

en.wikipedia.org/wiki/Coronavirus_disease_2019

Union Health Ministry launches India’s 1st indigenous rotavirus vaccine Rotavac by Share GK

The Union Ministry of Health and Family Welfare launched India’s 1st indigenous rotavirus vaccine named Rotavac to combat infant mortality due to diarrhoea. It was launched by the Union Health Minister J.P. Nadda as part country’s ambitious Universal Immunisation Programme (UIP). The vaccine is b... www.sharegk.com/curent-affairs/goverment-current-affairs/...

‪#‎gk‬ ‪‪#‎EntranceExam‬ ‪#‎OnlineTest‬ ‪#‎Aptitude‬‬

THE WALL by Vincenzo Pisani

16 38

The Israeli West Bank barrier is a separation barrier being constructed by the State of Israel along and within the West Bank. Upon completion, the barrier’s total length will be approximately 760 Km (twice the length of the 1949 Armistice Line (Green Line) between the West Bank and Israel). The barrier is a fence with vehicle-barrier trenches surrounded by an on average 60 meter wide exclusion area (90% of its length), and an 8 meter tall concrete wall (10% of its length). The barrier is built mainly in the West Bank and partly along the 1949 Armistice line, or "Green Line" between Israel and Palestinian West Bank. 12% of the West Bank area is on the Israel side of the barrier.

Supporters argue that the barrier is necessary to protect Israeli civilians from Palestinian terrorism, including the suicide bombing attacks that increased significantly during the Second Intifada. There has been a reduced number of incidents of suicide bombings since the construction of the barrier. Supporters argue that this is indicative of the barrier being effective in preventing such attacks.

Opponents of the barrier object that the route substantially deviates from the Green Line into the occupied territories captured by Israel in the Six-Day War of 1967. They argue that the barrier is an illegal attempt to annex Palestinian land under the guise of security, violates international law, has the effect of pre-empting final status negotiations, and severely restricts Palestinians who live nearby, particularly their ability to travel freely within the West Bank and to access work in Israel.

In a 2004 advisory opinion, the International Court of Justice considered that "Israel cannot rely on a right of self-defence or on a state of necessity in order to preclude the wrongfulness of the construction of the wall". The Court found that "the construction of the wall, and its associated régime, are contrary to international law".

Some Jewish settlers condemn the barrier for appearing to renounce the Jewish claim to the whole of the Land of Israel.

Two similar barriers, the Israeli Gaza Strip barrier and the Israeli-built 7-9 meter (23 – 30 ft) wall separating Gaza from Egypt (temporarily breached on January 23, 2008), which is currently under Egyptian control, are also controversial.

Most of the barrier (over 95% of total length) consists of a "multi-layered fence system". The IDF's preferred design has three fences, with pyramid-shaped stacks of barbed wire for the two outer fences and a lighter-weight fence with intrusion detection equipment in the middle. Patrol roads are provided on both sides of the middle fence, an anti-vehicle ditch is located on the West Bank side of the fence, and a smooth dirt strip on the Israeli side for "intrusion tracking".

In a 2005 report, the United Nations stated that:

“...it is difficult to overstate the humanitarian impact of the Barrier. The route inside the West Bank severs communities, people’s access to services, livelihoods and religious and cultural amenities. In addition, plans for the Barrier’s exact route and crossing points through it are often not fully revealed until days before construction commences. This has led to considerable anxiety amongst Palestinians about how their future lives will be impacted...The land between the Barrier and the Green Line constitutes some of the most fertile in the West Bank. It is currently the home for 49,400 West Bank Palestinians living in 38 villages and towns.”

Médecins du Monde, the Palestinian Red Crescent Society and Physicians for Human Rights-Israel have stated that the barrier "harms West Bank health". Upon completion of the construction, the organizations predict, the barrier would prevent over 130,000 Palestinian children from being immunised, and deny more than 100,000 pregnant women (out of which 17,640 are high risk pregnancies) access to healthcare in Israel. In addition, almost a third of West Bank villages will suffer from lack of access to healthcare. After completion, many residents may lose complete access to emergency care at night. In towns near Jerusalem (Abu Dis and al-Eizariya), for example, average time for an ambulance to travel to the nearest hospital has increased from 10 minutes to over 110 minutes.

A report from Physicians for Human Rights-Israel states that the barrier imposes "almost-total separation" on the hospitals from the population they are supposed to serve. The report also noted that patients from the West Bank visiting Jerusalem's Palestinian clinics declined by half from 2002 to 2003.

The Red Cross has declared the barrier in violation of the Geneva Convention. On February 18, 2004, The International Committee of the Red Cross stated that the Israeli barrier "causes serious humanitarian and legal problems" and goes "far beyond what is permissible for an occupying power".

According to EU foreign policy chief Catherine Ashton, the EU considers the barrier to be illegal to the extent it is built on Palestinian land.

Israeli public opinion has been very strongly in favor of the barrier, partly in the hope that it will improve security and partly in the belief that the barrier marks the eventual border of a Palestinian state. Due to the latter possibility, the settler movement opposes the barrier, although this opposition has waned since it became clear the barrier would be diverted to the east of major Israeli settlements such as Ariel.

According to Haaretz, a survey conducted by the Tami Steinmetz Center for Peace Research, Tel Aviv University, there is an overwhelming support for the barrier among the Jewish population of Israel: 84% in March 2004 and 78% in June 2004.

The Palestinian population and its leadership are essentially unanimous in opposing the barrier. A significant number of Palestinians have been separated from their own farmlands or their places of work or study, and many more will be separated as the barriers near Jerusalem are completed.

Furthermore, because of its planned route as published by the Israeli government, the barrier is perceived as a plan to confine the Palestinian population to specific areas. They state that Palestinian institutions in Abu Dis will be prevented from providing services to residents in the East Jerusalem suburbs, and that a 10-minute walk has become a 3-hour drive in order to reach a gate, to go (if allowed) through a crowded military checkpoint, and drive back to the destination on the other side.

More broadly, Palestinian spokespersons, supported by many in the Israeli left wing and other organizations, claim that the hardships imposed by the barrier will breed further discontent amongst the affected population and add to the security problem rather than solving it.

Guide to the West Bank Barrier (BBC News): news.bbc.co.uk/2/shared/spl/hi/guides/456900/456944/html/...

LOAD6 20141026 Frozen Party_3600 by Melissa Shanhun

5 11

When you were invited to Elizabeth and Annie’s Princess dress up party there was no doubt who you wanted to be. You had borrowed an Ariel costume for the last party so I decided to splurge on a new costume, hair clips and a necklace When I arrived home from Lucy’s immunisations with this dress you were so excited, you thanked me right away. You couldn’t wait for the accessories to arrive in the mail.

We watched the movie together a while before the party.

A night at Sally Bowles in Berlin by Genderfluid Ashleigh

Fully immunised, and with some proper precautions I can go out again last week.

It has been so frustrating having bought all these wonderful shoes, skirts, clothes and pantyhose and nit being able to show them off.

One of my favourite cocktail lounges in Berlin, is Sally Bowles, which is themed around the Cabaret era and named after its female lead.

The skirt, which suited the theme of Sally Bowles is from my favourite Australian designer, Alannah Hill, during her heyday. Sadly that label has deteriorated since she was forced out of the business.

The glitzy evening heels are by Aldo, the pantyhose are black Wolford Neon 40 and the lace gloves are from Kitten D’Amour in Brisbane.

Unfortunately I didn’t quite capture the sexy blac lace top from Wolford..

Flint after his immunisations by sezohanim

8 23

He is lethargic and most unlike his usual self. We really wonder if it was necessary.

HE IS NOW BACK TO HIS NORMAL ENERGETIC AND PLAYFUL SELF! ;-))

Doctor immunising a child, 1941 by State Library of Queensland

6 2

Creator: Unidentified.

Location: Brisbane, Queensland.

Description: Dr. Weaver immunising a child while a nurse looks on, Brisbane, 1941. Sunday Sun Collection. 25 June 1941.

View the original image at the State Library of Queensland: hdl.handle.net/10462/deriv/96937

Information about State Library of Queensland’s collection: www.slq.qld.gov.au/resources/picture-queensland

You are free to use this image without permission. Please attribute State Library of Queensland.

Bracing for a short, sharp jab by DFID - UK Department for International Development

Nine month old Emabet is about to receive her measles vaccination, in Ethiopia's Merawi province.

One in ten children across Ethiopia do not live to see their fifth birthday, with many dying of preventable diseases, like measles, pneumonia, malaria and diarrhoea.

But British aid has helped to double immunisation rates across Ethiopia in the past five years, by funding medicines, equipment and training for doctors and nurses.

Additional funding from the UK and other countries will help GAVI roll out new, life-saving vaccines in other countries around the world.

To find out more, please see the full story at: www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...

Picture: Pete Lewis / DFID

Terms of use

This image is posted under a Creative Commons - Attribution Licence, in accordance with the Open Government Licence. You are free to embed, download or otherwise re-use it, as long as you credit the source as 'Pete Lewis / Department for International Development'.

Preparing a measles vaccine in Ethiopia by DFID - UK Department for International Development

16 3

A nurse at Merawi health centre in northern Ethiopia prepares a measles vaccine for delivery.

Ethiopia is one of more than 70 developing countries benefitting from the support of the GAVI Alliance.

Three years ago, there were fewer than 750 health centres across Ethiopia. Now, thanks in part to support from British aid, there are more than 2100 health centres providing vaccinations and other life-saving care.

To find out more, about how UK aid is working in Ethiopia, please visit: www.gov.uk/government/priority/supporting-development-in-...

Picture: Pete Lewis / DFID

Terms of use

Sky Tree by XPAT-Polska

Forgive me if I don't comment much, but my back problem has got worse and is now serious. I have to do physio every 90 minutes until the pain in my legs (which stops me from walking) eases - otherwise there is a danger I may have permanent nerve damage and end up on wheels. I am not allowed to bend in any way which makes life difficult.

To make matters worse I have been diagnosed as being bitten by a Tick.

Today I had a bood test to determine if I have an infection - I have a growing ring of angry red on my thigh which is spreading and which was wrongly diagnosed as a fungal infection. The good news is I am immunised against 'Lymes Disease ' which affectes the brain and is incurable. Apparently this bite must have happened 2 months ago and only showed up when I was on holiday in Italy a month ago.

I am OK, but not in the best of mental health. I am taking antobiotics and other medications.

Comments have been disabled here until I'm feeling better, but I will continue to post.

Not fair of me to expect comments if I am unable to make them myself.

Update - comments box reinstated Sept 2013

Immunised by badger_beard

5 3

A year to the day since the first English lockdown started I got my Covid-19 vaccination at The Grafton, Cambridge

Mothers comfort their children after immunisations by DFID - UK Department for International Development

9 1

Babies are comforted after being vaccinated at the Jembe Community Health Centre in Bo District, southern Sierra Leone.

Their mothers know the seconds of pain their children have had to endure will give them the best chance of surviving diseases like diarrhoea and pneumonia, which account for over 40% of child deaths in Sierra Leone.

To find out more, please see the full story at: www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...

Covid Vaccination Centre - Sheffield Arena, UK by Tim Dennell

5 1

Coronavirus album:

www.flickr.com/photos/shefftim/albums/72157713538756686

You know you're in Japan when this drives down the road. by The 10 Thousand Things

10 5

Minolta srT-101

MC W.Rokkor 28mm f/2.8

Kodak Gold 200

...I've lived here a long time, so generally I am pretty well immunised against "WTF Japan" moments... but this one got me.

The U.K. COVID-19 vaccination schedule starts this week! by Paul Ellis

3 4

The COVID-19 virus had seriously disrupted our existence these past ten months and most probably for a long, long time to come. Although at present we are trying to reduce its spread by using masks, social distancing and improved general public hygiene, the only way to drastically reduce its spread is by vaccination,.

The first doses of vaccine have been delivered to hospitals here and the immunisation program is due to start tomorrow. Hopefully the vast majority of people will take up this entirely free and voluntary injection. It is the only way to reduce the occurrence of this virus amongst our population.

Here in the U.K., the the incidence of infection is about 1 in 110. My niece, working in pathology at a major hospital in Dallas, Texas, USA, has told us that the incidence of positive tests in her hospital is 1 in 4!

These figures do not need any explanation. They speak for themselves.

Providing hope for a better future by DFID - UK Department for International Development

Mariatu Kamara lost a son to pneumonia a year ago in Sierra Leone. He was just one year old.

“I did manage to get him to hospital,” she says, “but there was nothing they could do and he died during the night.”

Mariatu, who is now four months pregnant with another child, found out about the new pneumococcal vaccine during an antenatal check-up.

“I was so happy to hear about the new vaccine that will help to stop babies like mine from dying of pneumonia,” she says. “And, of course, when my new baby is born I will take him or her to the clinic to be vaccinated.”

Every year, two million children like Mariatu's son die of diseases that can be prevented by immunisation. That's one child every 20 seconds.

Vaccinations offer a simple, cost-effective solution to this problem. For the price of a cup of coffee a child can be vaccinated against five of the major childhood killers, including Hepatitis B, diphtheria and tetanus.

To find out more about UK aid is helping prevent millions of preventable deaths, please see the full story at: www.dfid.gov.uk/Media-Room/Features/2011/One-simple-jab-m...

A night at Sally Bowles in Berlin by Genderfluid Ashleigh

Fully immunised, and with some proper precautions I can go out again last week.

It has been so frustrating having bought all these wonderful shoes, skirts, clothes and pantyhose and nit being able to show them off.

One of my favourite cocktail lounges in Berlin, is Sally Bowles, which is themed around the Cabaret era and named after its female lead.

The glitzy evening heels are by Aldo, the pantyhose are black Wolford Neon 40 and the lace gloves are from Kitten D’Amour in Brisbane.

Unfortunately I didn’t quite capture the sexy blac lace top from Wolford..

National Cancer Institute of Colombia by Pan American Health Organization PAHO

Women are immunized against cervical cancer and pap smears are conducted in the HPV Immunisation room. Bogota, Colombia.

A night at Sally Bowles in Berlin by Genderfluid Ashleigh

Fully immunised, and with some proper precautions I can go out again last week.

It has been so frustrating having bought all these wonderful shoes, skirts, clothes and pantyhose and nit being able to show them off.

One of my favourite cocktail lounges in Berlin, is Sally Bowles, which is themed around the Cabaret era and named after its female lead.

The glitzy evening heels are by Aldo, the pantyhose are black Wolford Neon 40 and the lace gloves are from Kitten D’Amour in Brisbane.

Unfortunately I didn’t quite capture the sexy blac lace top from Wolford..

Anticipation by Kristen Elsby

10 4

A young girl living in a government relief camp in Dadu cries in anticipation of the immunization injection she is about to receive for measles and polio from a lady health worker. Since the devastating monsoon floods struck seven months ago, more than 12.7 million children have received polio immunizations and more than 11.3 million children have received measles immunizations through UNICEF. Campaigns have also started among displaced children in Mohmand Agency in FATA.

Dadu, Sindh Province, Pakistan, 2011

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