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Global health

Pandemic Fatigue Could Cause Problems For Public Health

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As most people get tired of dealing with the pandemic, experts worry Congress will too, which could affect vaccines, tests and other policies.

It’s been a long pandemic, and COVID still isn’t fully gone. Now, monkeypox and polio have entered the conversation.

Many are still trying to figure out what a degree of normalcy looks like, but as tired as people are, how much worse is it for the actual public health system?

It’s led to a whole array of challenges for public health, and that could have major consequences for an already weary U.S. health system.

While public health got a boost in funding during the heights of the pandemic, the Biden administration is already pulling back on funding for tests and vaccines because of a lack of funding from Congress.

It worries experts like Thoai Ngo, an epidemiologist working at the health justice research nonprofit the Population Council.

“My main worry right now is that because of how we operate, we will erode trust from people in public health institutions,” Ngo said. “We will make it harder for us to control and manage the current epidemics: COVID-19, monkeypox, polio and future epidemics.”

So, what does the U.S. public health picture look like with COVID now?

Related StoryThe CDC Is Restructuring Its Agency Amid Public CriticismThe CDC Is Restructuring Its Agency Amid Public Criticism

Federal officials in places like the White House and CDC celebrate the role vaccines have played in preventing severe disease and death. The numbers show they definitely have, with COVID deaths in the last few months largely staying at a low point that we only saw briefly last spring and summer.

The CDC has used this as the basis for its new guidance from mid-August, which do away with the recommendations to practice social distancing and to quarantine if exposed to COVID.

It’s that reduction in severe disease and death that has underpinned the rollback of universal mask mandates nationwide and vaccine mandates in many places. 

Dr. Shira Doron, a hospital epidemiologist at Tufts Medical Center, has helped advise officials in Massachusetts on COVID policies, including in schools. She welcomes some of the new policies that roll back restrictions now that ways to prevent severe outcomes are readily available.

“The fact that we have all of those layers now, vaccines, tests and treatments just puts us in a completely different place in terms of that risk of severe disease, which is what we care about, which is the only thing we can hear about because we just can’t prevent infection,” Dr. Doron said. “That infection is too contagious.”

But even with low death rates, the U.S. is still losing more than 500 people every day. That means the U.S. is still losing as many Americans from COVID-19 in two weeks as it lost from two decades of fighting in Iraq and Afghanistan.

For those who center their work on immunocompromised people, policies rooted in fatigue with the virus look like an admission that the virus has won.

“I just think that, particularly with the recent CDC guideline, it’s confirming to me that the Biden administration and our federal health officials have given up on controlling infections of COVID-19, and they left the vulnerable, the elderly, the immunocompromised, people with disability in the cold,” Ngo said.

Then there’s long COVID, which is more than just a few extra weeks of the sniffles.

It’s personal for Elizabeth Jacobs. She’s an epidemiologist at the University of Arizona who has two illnesses that suppress her immune system. 

“We’re seeing things like fatigue,” Jacobs said. “That is really hard to describe. I think that a lot of people use fatigue in the colloquial sense of, ‘I’m just tired.’ But for somebody like me who has genuine fatigue caused by autoimmune diseases, it’s not like that. It’s more like you have cement blocks tied to your legs and arms, and you just can’t really even move around a lot. You have trouble getting out of bed and even sitting up in front of a computer is really difficult.”

Beyond her concern about her own risk if she contracts COVID, Jacobs worries that a shift away from preventing infection could make it harder to solve other problems tied to it. 

“Is it that people are tired of mitigation with masking, or is it that we are tired of things like flight cancellations and supply chain issues and having our children out sick from school and needing to care for our loved ones and seeing our neighbors die?” Jacobs asked. “Because if it’s the latter that is causing fatigue in us, then that is not being caused by mitigation. It’s being caused by the lack of mitigations.”

Then, there’s monkeypox.

In short, public health officials at federal and local levels have said they believe the response started slower than it should have. Tests and vaccines have also been hard to come by, although there’s hope that new shipments in the coming months should make it easier to vaccinate people at risk.

It sounds similar to some of the early missteps in addressing COVID-19, and that might not be a coincidence.

“The response to monkeypox, from what I can tell, is very much influenced by the law over the last two years of COVID, right?” said Jared Auclair, director of the biopharmaceutical analysis and training lab at Northeastern University. “People just don’t want to think about it and just don’t want to deal with it. Taking that mindset of slow rolling into a response because you are exhausted from COVID and don’t want to, you don’t want to have any repercussions like you’re being alarmist.”

Related StoryChildren, College Students Diagnosed With Monkeypox Raise AlarmChildren, College Students Diagnosed With Monkeypox Raise Alarm

The good news about vaccine demand outstripping supply is that there’s a high degree of interest from at-risk groups. Monkeypox is primarily affecting gay and bisexual men who have sex with men. 

“In general, that community has been very direct and forthcoming about wanting to take steps to to to protect itself and others,” said Jen Kates, director of the global health and HIV policy Program at the Kaiser Family Foundation.

While those affected by monkeypox aren’t putting aside getting their shots, pandemic fatigue is having a knock-on effect for other outbreaks.

“What has happened though is because of this pushback on the public health authorities putting in place requirements or guidance, there’s been an increasing move, as we’ve seen across the country, to attack, to sort of apply this to other public health interventions,” Kates said. “Well, we don’t want our children to be forced to have immunizations for schools, things like that, which is frankly very dangerous.”

So polio, diphtheria and all those other diseases many get vaccinated against without thinking about as a kid — if pandemic fatigue continues to translate to underfunding public health, all of those could also come back.

“The worst case scenario of that is that we get used to having those old diseases come back, that we have children dying of diphtheria, we have communities impacted by polio and… with limited resources,” said Amanda McClelland, senior vice president of the Prevent Epidemics Team at Resolve to Save Lives.

Even going back to COVID, the message from public health experts about how to keep things from getting much worse is to invest in the tools we need to keep risk low.

“I am not terribly concerned about pandemic fatigue when experienced by somebody with a fair amount of immunity, but I am concerned about Congress having pandemic fatigue,” Dr. Doron said. “I think that it is still really important that the government be focused on COVID-19, even though I don’t think every individual needs to be so focused on COVID-19 anymore because we can be pretty safe if the government continues to fund the things that are keeping us safe.”

: newsy.com

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Filed Under: POLITICS, TRENDING, US Tagged With: Afghanistan, Arizona, Autoimmune Diseases, Biden administration, Children, Communities, Country, COVID-19, Disability, Elderly, Epidemics, Family, Global health, Government, Health, Immune System, Infections, Iraq, Kaiser Family Foundation, Law, Long Covid, Massachusetts, Men, Monkeypox, neighbors, Policy, Polio, Population, Research, Schools, Sex, Students, Summer, Supply Chain

Polio Spreading: Virus Found In New York City Wastewater

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Health officials in New York City have now detected the virus that causes polio in wastewater.

Polio is now spreading in cities like New York, London and Jerusalem.

Eric Cioé-Peña is the director of global health for Northwell Health.

“For most people, it means check your vaccination status and make sure you’re vaccinated against polio,” Cioé-Peña said. 

New York City health officials are on high alert after a recent detection of Polio virus in the city’s wastewater. 

“We eradicated Polio from the United States using vaccination. The only reason why it’s back is because some people have opted not to vaccinate either their children or themselves. There is no other way that Polio can exist in the United States, period,” Cioé-Peña said.

Last month, a case of paralysis from Polio was identified in an unvaccinated young adult in Rockland County, 30 miles north of New York City. 

Dr. José Romero is the director of the CDC’s National Center for Immunization and Respiratory Diseases. 

“It’s the rare case that causes paralysis, so that means there must be several hundred other cases in the community circulating before you see this one case,” Romero said.  

The CDC says about one out of every four infected people have flu-like symptoms. 

It can sometimes be confused with other illnesses.

“That is, you know, one of the reasons why it’s called a silent killer is because, you know, it’s really tough to predict who’s going to have that other than the fact that they’re not fully vaccinated,” Cioé-Peña said.

The CDC says roughly one in 200 infections can lead to partial or full paralysis.

Between two and 10 out of 100 of those people die. 

For the first half of the 20th century, Polio terrified parents around the world.

Experts say the virus mainly affects children under five, but any person can get it if not vaccinated. 

Health experts say it can spread and mutate into a harmful version of the virus in under-vaccinated communities. 

In Rockland County, vaccination rates are about 60%, compared with 93% nationwide. 

“In Rockland County, there was communities where we dropped below the acceptable vaccination rates that herd immunity was no longer protective and we started seeing cases again,” Cioé-Peña said.

The CDC says Polio virus is very contagious and spreads through person-to-person contact, contaminated food, and unsanitary water conditions. 

: newsy.com

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Filed Under: TRENDING Tagged With: Children, Cities, Communities, Food, Global health, Health, Infections, Jerusalem, London, National, National Center for Immunization and Respiratory Diseases, New York, New York City, Polio, Respiratory Diseases, United States, Water, York

There Is A Nationwide Shortage Of Monkeypox Vaccines

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Health officials are now considering splitting the monkeypox vaccine dose due to a shortage of supply.

There is a shortage of monkeypox vaccines. 

Health officials are now considering splitting the doses. 

Doctor Eric Cioè Peña is the director of Global Health at Northwell Health in New York City. 

“The idea is, is that if you’re able to give someone the smallest amount of dose, that still induces immunity,” Cioè Peña said. 

The new plan under consideration is to split one dose into five, an approach the Federal Food and Drug Administration says is safe. 

Dr. Cioè Peña doesn’t think there’s enough data available on this approach, called dose sparing. 

“Im assuming that it’s based on data that they’re seeing immune response at much lower doses,” he said. 

The Biden administration’s move to declare monkeypox a public health emergency is intended to speed up vaccine distribution.  

Dr. Ashish Jha is the White House COVID-19 response coordinator. 

“About 1.6 million Americans are in that high-risk group that needs to be, and that should get vaccinated,” Jha said.  

Health officials across state lines said that only the most vulnerable should be seeking a vaccine.  

“We’re also giving it out to groups that are at high risk. Where there’s lots of monkeypox transmission right now, which are primarily men who identify as having sex with other men,” Cioè Peña said. 

According to the latest CDC numbers, the U.S. leads the world in infections with more than 7,100 cases. 

Monkeypox is now appearing in wastewater in five states: California, Georgia, Michigan, Texas and Idaho. Wastewater samples are often an early warning of community spread.  

In Chicago, officials are saying to “use common sense” ahead of this weekend’s Market Days Festival. More than 100,000 people are expected to attend this popular LGBTQ+ event. 

The virus is still spreading mostly among men who have sex with men, but health officials advise everyone is at risk because it spreads from close skin-to-skin contact. 

: newsy.com

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Filed Under: POLITICS, TRENDING, US Tagged With: Biden administration, California, Chicago, COVID-19, Food, Food and Drug Administration, Georgia, Global health, Health, Idaho, Infections, Men, Michigan, Monkeypox, New York, New York City, Sex, State, Texas, York

New York City Declares Monkeypox A Public Health Emergency

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By Associated Press
July 30, 2022

New York state health department called monkeypox an “imminent threat to public health.”

Officials in New York City declared a public health emergency due to the spread of the monkeypox virus Saturday, calling the city “the epicenter” of the outbreak.

The announcement Saturday by Mayor Eric Adams and health Commissioner Ashwin Vasan said as many as 150,000 city residents could be at risk of infection. The declaration will allow officials to issue emergency orders under the city health code and amend code provisions to implement measures to help slow the spread.

In the last two days, New York Gov. Kathy Hochul declared a state disaster emergency declaration and the state health department called monkeypox an “imminent threat to public health.”

New York had recorded 1,345 cases as of Friday, according to data compiled by the Centers for Disease Control and Prevention. California had the second-most, with 799.

“We will continue to work with our federal partners to secure more doses as soon as they become available,” Adams and Vasan said in the statement. “This outbreak must be met with urgency, action, and resources, both nationally and globally, and this declaration of a public health emergency reflects the seriousness of the moment.”

The World Health Organization declared monkeypox a global health emergency on July 23. The once-rare disease has been established in parts of central and west Africa for decades but was not known to spark large outbreaks beyond the continent or to spread widely among people until May, when authorities detected dozens of epidemics in Europe, North America and elsewhere.

To date, there have been more than 22,000 monkeypox cases reported in nearly 80 countries since May, with about 75 suspected deaths in Africa, mostly in Nigeria and Congo. On Friday, Brazil and Spain reported deaths linked to monkeypox, the first reported outside Africa. Spain reported a second monkeypox death Saturday.

The virus spreads through prolonged and close skin-to-skin contact as well as sharing bedding, towels and clothing. In Europe and North America, it has spread primarily among men who have sex with men, though health officials emphasize that the virus can infect anyone.

The type of monkeypox virus identified in this outbreak is rarely fatal, and people usually recover within weeks. But the lesions and blisters caused by the virus are painful.

Additional reporting by The Associated Press.

: newsy.com

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Filed Under: TRENDING Tagged With: Africa, Associated Press, Brazil, California, Centers for Disease Control and Prevention, Epidemics, Eric Adams, Europe, Global health, Health, Kathy Hochul, Men, Monkeypox, New York, New York City, Nigeria, North America, Sex, Spain, State, World Health Organization, York

UN Health Agency Chief Declares Monkeypox A Global Emergency

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The declaration could spur further investment in treating the once-rare disease and worsen the scramble for scarce vaccines.

The chief of the World Health Organization said the expanding monkeypox outbreak in more than 70 countries is an “extraordinary” situation that now qualifies as a global emergency, a declaration Saturday that could spur further investment in treating the once-rare disease and worsen the scramble for scarce vaccines.

WHO Director-General Tedros Adhanom Ghebreyesus made the decision to issue the declaration despite a lack of consensus among experts serving on the U.N. health agency’s emergency committee. It was the first time the chief of the U.N. health agency has taken such an action.

“We have an outbreak that has spread around the world rapidly through new modes of transmission about which we understand too little and which meets the criteria in the international health regulations,” Tedros said.

“I know this has not been an easy or straightforward process and that there are divergent views among the members” of the committee, he added.

A global emergency is WHO’s highest level of alert, but the designation does not necessarily mean a disease is particularly transmissible or lethal. WHO’s emergencies chief, Dr. Michael Ryan, said the director-general made the decision to put monkeypox in that category to endure the gobal community takes the current outbreaks seriously.

Although monkeypox has been established in parts of central and west Africa for decades, it was not known to spark large outbreaks beyond the continent or to spread widely among people until May, when authorities detected dozens of epidemics in Europe, North America and elsewhere.

Declaring a global emergency means the monkeypox outbreak is an “extraordinary event” that could spill over into more countries and requires a coordinated global response. WHO previously declared emergencies for public health crises such as the COVID-19 pandemic, the 2014 West African Ebola outbreak, the Zika virus in Latin America in 2016 and the ongoing effort to eradicate polio.

The emergency declaration mostly serves as a plea to draw more global resources and attention to an outbreak. Past announcements had mixed impact, given that the U.N. health agency is largely powerless in getting countries to act.

Last month, WHO’s expert committee said the worldwide monkeypox outbreak did not yet amount to an international emergency, but the panel convened this week to reevaluate the situation.

According to the U.S. Centers for Disease Control and Prevention, more than 16,000 cases of monkeypox have been reported in 74 countries since about May. To date, monkeypox deaths have only been reported in Africa, where a more dangerous version of the virus is spreading, mainly in Nigeria and Congo.

In Africa, monkeypox mainly spreads to people from infected wild animals like rodents, in limited outbreaks that typically have not crossed borders. In Europe, North America and elsewhere, however, monkeypox is spreading among people with no links to animals or recent travel to Africa.

WHO’s top monkeypox expert, Dr. Rosamund Lewis, said this week that 99% of all the monkeypox cases beyond Africa were in men and that of those, 98% involved men who have sex with men. Experts suspect the monkeypox outbreaks in Europe and North America were spread via sex at two raves in Belgium and Spain.

“Although I am declaring a public health emergency of international concern for the moment, this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners,” Tedros said. “That means that this is an outbreak that can be stopped with the right strategies in the right groups.”

Emergencies chief Ryan, explained what preceded the director-general’s decision.:

“(Tedros) found that the committee did not reach a consensus, despite having a very open, very useful, very considered debate on the issues, and that since he’s not going against the committee, what he’s recognizing is that there are deep complexities in this issue,” Ryan said. “There are uncertainties on all sides. And he’s reflecting that uncertainty and his determination of the event” to be a global emergency.

Before Saturday’s announcement, Michael Head, a senior research fellow in global health at Southampton University, said it was surprising WHO hadn’t already declared monkeypox a global emergency, explaining that the conditions were arguably met weeks ago.

Some experts had questioned whether such a declaration would help, arguing the disease isn’t severe enough to warrant the attention and that rich countries battling monkeypox already have the funds to do so; most people recover without needing medical attention, although the lesions may be painful.

“I think it would be better to be proactive and overreact to the problem instead of waiting to react when it’s too late,” Head said. He added that WHO’s emergency declaration could help donors like the World Bank make funds available to stop the outbreaks both in the West and in Africa, where animals are the likely natural reservoir of monkeypox.

In the U.S., some experts have speculated whether monkeypox might be on the verge of becoming an entrenched sexually transmitted disease in the country, like gonorrhea, herpes and HIV.

“The bottom line is we’ve seen a shift in the epidemiology of monkeypox where there’s now widespread, unexpected transmission,” said Dr. Albert Ko, a professor of public health and epidemiology at Yale University. “There are some genetic mutations in the virus that suggest why that may be happening, but we do need a globally-coordinated response to get it under control,” he said.

Ko called for testing to be immediately scaled up rapidly, saying that similar to the early days of COVID-19, that there were significant gaps in surveillance.

“The cases we are seeing are just the tip of the iceberg,” he said. “The window has probably closed for us to quickly stop the outbreaks in Europe and the U.S., but it’s not too late to stop monkeypox from causing huge damage to poorer countries without the resources to handle it.”

In the U.S., some experts have speculated that monkeypox might become entrenched there as the newest sexually transmitted disease, with officials estimating that 1.5 million men are at high risk of being infected.

Dr. Placide Mbala, a virologist who directs the global health department at Congo’s Institute of National Biomedical Research, said he hoped any global efforts to stop monkeypox would be equitable. Although countries including Britain, Canada, Germany and the U.S. have ordered millions of vaccine doses, none have gone to Africa.

“The solution needs to be global,” Mbala said, adding that any vaccines sent to Africa would be used to target those at highest risk, like hunters in rural areas.

“Vaccination in the West might help stop the outbreak there, but there will still be cases in Africa,” he said. “Unless the problem is solved here, the risk to the rest of the world will remain.”

Additional reporting by the Associated Press.

: newsy.com

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Filed Under: TRENDING Tagged With: Africa, Animals, Associated Press, Belgium, Canada, Centers for Disease Control and Prevention, COVID-19, Epidemics, Europe, Germany, Global health, Health, Latin America, Men, Monkeypox, National, Nigeria, North America, Research, Rodents, Rural Areas, Sex, Spain, Surveillance, Tedros Adhanom Ghebreyesus, travel, World Bank, World Health Organization, Yale University

WHO Again Considers Declaring Monkeypox A Global Emergency

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Monkeypox has been entrenched for decades in Africa. It’s circulated in Europe, North America and beyond since May among gay and bisexual men.

As the World Health Organization’s emergency committee convenes Thursday to consider for the second time within weeks whether to declare monkeypox a global crisis, some scientists say the striking differences between the outbreaks in Africa and in developed countries will complicate any coordinated response.

African officials say they are already treating the continent’s epidemic as an emergency. But experts elsewhere say the mild version of monkeypox in Europe, North America and beyond makes an emergency declaration unnecessary even if the virus can’t be stopped. British officials recently downgraded their assessment of the disease, given its lack of severity.

Monkeypox has been entrenched for decades in parts of central and western Africa, where diseased wild animals occasionally infect people in rural areas in relatively contained epidemics. The disease in Europe, North America and beyond has circulated since at least May among gay and bisexual men. The epidemic in rich countries was likely triggered by sex at two raves in Spain and Belgium.

Some experts worry these and other differences could possibly deepen existing medical inequities between poor and wealthy nations.

There are now more than 15,000 monkeypox cases worldwide. While the United States, Britain, Canada and other countries have bought millions of vaccines, none have gone to Africa, where a more severe version of monkeypox has already killed more than 70 people. Rich countries haven’t yet reported any monkeypox deaths.

Related StoryNew Yorkers Scramble To Get Monkeypox VaccineNew Yorkers Scramble To Get Monkeypox Vaccine

“What’s happening in Africa is almost entirely separate from the outbreak in Europe and North America,” said Dr. Paul Hunter, a professor of medicine at Britain’s University of East Anglia who previously advised WHO on infectious diseases.

The U.N. health agency said this week that outside of Africa, 99% of all reported monkeypox cases are in men and of those, 98% are in men who have sex with other men. Still, the disease can infect anyone in close, physical contact with a monkeypox patient, regardless of their sexual orientation.

“In these very active gay sexual networks, you have men who really, really don’t want people to know what they’re doing and may not themselves always know who they are having sex with,” Hunter said.

Some of those men may be married to women or have families unaware of their sexual activity, which “makes contact tracing extremely difficult and even things like asking people to come forward for testing,” Hunter said, explaining why vaccination may be the most effective way to shut down the outbreak.

That’s probably not the case in Africa, where limited data suggests monkeypox is mainly jumping into people from infected animals. Although African experts acknowledge they could be missing cases among gay and bisexual men, given limited surveillance and stigmatization against LGBTQ people, authorities have relied on standard measures like isolation and education to control the disease.

Dr. Placide Mbala, a virologist who directs the global health department at Congo’s Institute of National Biomedical Research, said there are also noticeable differences between patients in Africa and the West.

“We see here (in Congo) very quickly, after three to four days, visible lesions in people exposed to monkeypox,” Mbala said, adding that someone with so many visible lesions is unlikely to go out in public, thus preventing further transmission.

But in countries including Britain and the U.S., doctors have observed some infected people with only one or two lesions, often in their genitals.

“You wouldn’t notice that if you’re just with that person in a taxi or a bar,” Mbala said. “So in the West, people without these visible lesions may be silently spreading the disease.”

He said different approaches in different countries will likely be needed to stop the global outbreak, making it challenging to adopt a single response strategy worldwide, like those for Ebola and COVID-19.

Dr. Dimie Ogoina, a professor of medicine at Nigeria’s Niger Delta University, said he feared the world’s limited vaccine supplies would result in a repeat of the problems that arose in the coronavirus pandemic, when poorer countries were left empty-handed after rich countries hoarded most of the doses.

“It does not make sense to just control the outbreak in Europe and America, because you will then still have the (animal) source of the outbreak in Africa,” said Ogoina, who sits on WHO’s monkeypox emergency committee.

This week, U.S. officials said more than 100,000 monkeypox vaccine doses were being sent to states in the next few days, with several million more on order for the months ahead. The U.S. has reported more than 2,000 cases so far, with hundreds more added every day.

Some U.S. public health experts have begun to wonder if the outbreak is becoming widespread enough that monkeypox will become a new sexually transmitted disease.

Declaring monkeypox to be a global emergency could also inadvertently worsen the rush for vaccines, despite the mildness of the disease being seen in most countries.

Dr. Hugh Adler, who treats monkeypox patients in Britain, said there aren’t many serious cases or infections beyond gay and bisexual men. Still, he said it was frustrating that more vaccines weren’t available, since the outbreak was doubling about every two weeks in the U.K..

“If reclassifying monkeypox as a global emergency will make (vaccines available), then maybe that’s what needs to be done,” he said. “But in an ideal world, we should be able to make the necessary interventions without the emergency declaration.”

Additional reporting by The Associated Press.

: newsy.com

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Filed Under: TRENDING Tagged With: Africa, Animals, Associated Press, Belgium, Canada, Coronavirus, COVID-19, Doctors, Education, Epidemics, Europe, Global health, Health, Infections, Infectious diseases, Medicine, Men, Monkeypox, National, Next, Niger, Nigeria, North America, Research, Rural Areas, Sex, Spain, Surveillance, United States, Women, World Health Organization

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