Coronavirus Updates October 2022

[missy]

Model Predicts COVID Deaths Will Flatline This Winter​

— IHME foresees almost eight-fold reduction in COVID deaths compared with last winter​

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today October 26, 2022

The U.S. probably won't see a major surge in COVID deaths this winter, according to new models from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle.
By Feb. 1, 2023, daily deaths are projected to be at a high point of 335, which pales in comparison to the approximate 2,500 daily deaths seen during the Omicron surge around the same time last year, according to a recently published IHME policy brief.

The report estimates the COVID-19 infection-fatality rate (IFR) to be below 0.2% as of October 17.
"Many people have been exposed to COVID-19, either through infection or through vaccination, [so we don't expect] a high hospitalization rate and high mortality rate," Ali Mokdad, PhD, a professor at IHME and chief strategy officer for population health at the University of Washington, told MedPage Today. "We will see a little bit of a rise, but it will not be as high as what we have seen in the past."
Also contributing to that flattening of the deaths curve is the fact that current and emerging variants appear less severe and unable to thwart humoral and cellular immunity -- though Mokdad warned that the appearance of a new variant that is more severe and immune-evasive could change those predictions. Nonetheless, he said, the probability of that happening is small.
Still, the U.S. will see some 30,000 deaths and globally there will be about 250,000 deaths by February 1, though this includes deaths where the virus was present but didn't necessarily cause or contribute to the deaths, according to the policy brief.

"Our inability to distinguish effectively between hospital admissions and deaths due to COVID-19 as compared to with COVID-19 hampers our understanding of the true impact of COVID-19 now," the policy brief stated.
Shaun Truelove, PhD, an epidemiologist at Johns Hopkins Bloomberg School of Public Health who works on its COVID-19 Scenario Modeling Hub, said his team has modeled several different scenarios for COVID this winter. The worst-case -- a powerful new variant coming along, as Mokdad noted -- would bring a peak of 1,000 deaths per day in this winter's surge.
"I'd like to think we have this rosy future, but I am skeptical still," Truelove told MedPage Today. "Looking at the number in February is fine, but more importantly, we need to think about this much sooner timeframe where we start to see increases in [cases] in the U.S., and those increases will lead to more deaths just by the nature of numbers."

As for infections, there's also unlikely to be a dramatic surge like the one caused by Omicron last winter, according to the report. At the beginning of February, the U.S. will see about 1 million infections per day, far lower than the estimated 5 million daily cases during Omicron's peak last year.
These cases, however, won't be reported, because people will be asymptomatic, mildly symptomatic, or won't report their at-home tests results to local health officials, Mokdad said. Currently, only about 5% of cases are being reported to health officials, according to the policy brief.
Daily hospitalizations will reach 26,000 in the U.S. by February 1, though no states are expected to have high or extreme stress on hospital beds or ICU capacity, according to IHME.
The reason for this hopeful picture comes down to immunity, Mokdad said. IHME estimates that 95% of people in the U.S. have been infected by the virus to date -- and that's not even counting vaccinated immunity, he said.

As part of that, about 62% of people in the U.S. have been infected with Omicron sublineages BA.1 and BA.2, and about 60% have been infected with BA.5, giving a large swath of the population recent immune memory that could help stave off infection.
"About 5 months after an infection or a vaccine, your immunity goes down," Mokdad said. "But the good news is that both infection and the vaccine give your B and T cells something to remember" to help fight the virus.
Lessons from around the world have helped IHME piece together what's likely to happen in the U.S. this winter. In Singapore, an Omicron variant called XBB caused a recent surge in infections, but that didn't translate to a higher hospitalization rate in this highly vaccinated country.
XBB showed almost no immune escape from a recent BA.5 infection, which will limit its impact globally, according to the report. It also appears to be slightly less severe than BA.5, Mokdad said.

In Germany, on the other hand, a recent surge did lead to an uptick in hospitalizations. Researchers still aren't sure exactly what's behind that surge, as there are many variants circulating in that country, including BA.5. Oktoberfest celebrations likely played some role, as people who hadn't participated in the festival in the past few years finally returned, though they were quite susceptible to the virus, Mokdad said.
The German surge seems to have peaked for now, but Mokdad said what happened there could happen in other places in Europe, and could eventually hit the U.S. -- though we are in "a better position than the Europeans to handle the next wave" because of our immunity wall.
What concerns Mokdad is China. There have been "mixed signals" from the country as to whether it will continue to aggressively pursue its zero-COVID policy.
If it decides against continuing that policy, there will be a "dramatic effect on infections, hospitalizations, and deaths," according to the report. The country's older population is less vaccinated than its younger population, and the vaccine itself isn't as protective as the mRNA shots used in the west, he said.

Though the U.S. won't see a similar fate, Mokdad said it's still important to protect vulnerable populations, especially older adults. He mentioned his 82-year-old mother, who has chronic health conditions. "We all have family members at high risk, so we need to be very careful," he said.
He added that IHME modeling shows that if 80% of the U.S. population wears a mask, daily deaths this winter will be cut by a third.
Boosters are also critically important, he said. He had four doses of vaccine before he was infected with Omicron earlier this year. He had minor symptoms that he thought were allergies, and he only tested because he wanted to go to the hospital where his wife was having a procedure.
When he discovered his positive test, he quarantined and didn't infect any other members of his household.
"Getting the booster now will protect against hospitalization," he said, adding that there's also the potential for a double threat of COVID and flu this winter.
"I wouldn't say we're in a good position, because our hospitals have been under a lot of pressure," Mokdad said. "It's possible we'll have a bad flu season, so the combination of the two could still overwhelm hospitals, especially in areas where you have high-risk people."

• 
  
  Kristina Fiore leads MedPage’s enterprise & investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others.

 

[missy]

Today's must-reads​

• Moderna and Pfizer bivalent boosters didn’t outperform original Covid shots, a small study found.
• Wuhan locked down one of its central districts, with some 900,000 residents, after Covid cases were found.
• High energy costs will lead to thermostats being turned downthis winter in Europe, posing a health challenge.

Designing a future-proof emergency room​

More than a year after work began to redesign an Ohio hospital’s emergency department, the Covid-19 pandemic forced architects to rethink their plans.

Designing a traditional emergency department doesn’t usually involve planning on a huge scale, says Brian Silva, vice president at CannonDesign, the firm responsible for the redesign at the University of Cincinnati Medical Center. When Covid hit, hospital officials recognized that they needed a design that could better serve the community in the case of future pandemic scenarios.

To prevent people with respiratory symptoms from co-mingling with others, the hospital put up tents outside the building where people could get screened for the virus. But just days later, 50-mile-an-hour winds took down the whole makeshift setup.

“As we were out there looking at these tents being blown down, we said we’ve got to figure out a better way of doing this,” said Bob Feldbauer, vice president of facilities for UC Health, which operates hospitals across Ohio.


Now UC Health is constructing an emergency department that can be easily switched to “pandemic mode,” which includes a separate entrance, triage space and treatment area for patients that may have respiratory illness. The hospital is also building a so-called alternate-care site, a separate area that can accommodate even more patients in the event of a pandemic or mass emergency. When it’s not being used for emergencies, the area can be used for other purposes, including as a public event space. Construction is expected to be completed by 2024.

In general, architects say health-care clients are increasingly looking for flexibility, pandemic support and emergency preparedness when it comes to building design.

During the early days of the pandemic, Francis Cauffman Architects, which has offices in New York, Philadelphia and Orlando, Florida, interviewed some of its clients at hospitals and outpatient facilities in order to understand the impact Covid was having on their day-to-day work.

Some people had resorted to taking doors off hinges and cutting windows in doors and walls to address ventilation concerns and allow greater visibility for high-risk patients, said Catherine Gow, the firm’s principal of health facilities planning.

FCA has used that information to help their team think about innovations and designs for the future projects, Gow said. Visibility into a room wasn’t a main concern for designing medical surgical units, however, window placement and sidelights have now become an important design consideration.

Covid has also sparked interest in being prepared for other events, said Diana Anderson, an architect and physician based in Boston. Clients, architects, and designers are thinking more about natural disasters, climate change and other emergency situations that a building might need to be ready for, she said.

What we’re reading​

Here are the districts where top abortion-focused super PACs are spending the most money ahead of midterm elections, according to an analysis by the 19th News.

Doctors that spread Covid-19-related misinformation and disinformation are facing increased scrutiny, Healthcare Brew reports.

Pediatricians are worried about the end of the federal Covid emergency, NPR reports.

 

[missy]

"

Fall bivalent boosters: Science update round 2​

KATELYN JETELINA

OCT 28

	​
Lab studies assessing the preliminary impact of our updated fall boosters are trickling in. (We don’t have “real world” data yet, and honestly, it may be a while.) In all, we knew boosters would help given circulating variants, but we didn’t know how much more helpful an updated formula would be. Here is the latest science and what it means in the broader context.

Purpose of the fall booster​

As a reminder, our hope with updated boosters was that they would accomplish three things:

1. Greater protection against infection and transmission, by boosting our first line of defense—neutralizing antibodies;
2. Longer protection against infection and severe disease, even just by a few months;
3. Broader protection or the ability to create antibodies that “see” more virus parts and “attach” more strongly compared to the antibodies we have right now.

My previous science update showed that #3 is being accomplished, which is great news. We won’t know about #2 for a few months. (We are at the mercy of time.) New science out this week gives some insight on #1.

Impact on neutralizing antibodies​

Two preprints were released this week (here and here) from two separate but respected labs in the U.S. Results swept mass media headlines. For example, an NPR headline stated: “Two new research papers cast doubt on the new COVID booster.”
What did the studies find? Do they really cast doubt on the booster?
Overall, both labs extracted blood from vaccinated and vaccinated + infected individuals 3-5 weeks after they received the fall booster. In a petri dish, the scientists measured how many neutralizing antibodies connected to subvariants once they were introduced. (They were not the new circulating subvariants, like XBB or BQ.1.1, unfortunately). Researchers found two things:

1. Neutralizing antibodies increased after the fall booster. Not surprising, but good to see.
2. Neutralizing antibodies were not higher after the fall booster compared to the original vaccine formula booster. Bummer.

​

Neutralization profiles of serum samples against SARS-CoV-2 variants and other sarbecoviruses. Source: Wang et al., Preprint.

Does this mean the fall booster isn’t working?​

Absolutely not.
First, an increase in neutralizing antibodies will help prevent infection and transmission in the short term. The old vaccine formula did this. The new formula does this. It’s not a surprise and will help.
Second, these studies extracted blood 3-5 weeks after people got the fall booster. The timeframe is important given the intricacies of the immune system.
When we come in contact with a virus or get a vaccine for the first time, our immune system develops B cells, which are antibody factories. Each B cell makes a single antibody shape, and they can pump out huge quantities of antibodies if needed. If you come in contact with another variant (or another vaccine formula), B cells can evolve and modify the antibodies they create for a new variant. This is just like factories that can modify their product on the line.
When the immune system sees a threat (like a fall booster) it wants to clear the threat in the fastest way possible. Responses based on memory work fastest, so instead of modifying the factory line, B cells get to work pumping out antibodies of shapes they’ve seen before. This is called “B cell memory.” It’s not until later that the B cells update their factory line and start pumping out updated antibodies. Research shows that, for COVID-19, this factory update happens at about 2 months after exposure (here, here). So, as shown in the figure below, an updated booster’s benefit may be marginal in the beginning, but better over time.

​

Orange=updated Beta booster; blue=original formula. Source: Nature Medicine

Bottom line​

The two preprints this week offered fantastic insight into the short-term impact of fall boosters. However, don’t be swayed by the headlines, as one or two preprints are not the whole story. We already have data showing the fall boosters provide broader protection. We have studies showing boosters boost neutralizing antibodies. We just may need time to see the full potential of an updated booster formula compared to the original.

Bottom bottom line​

Go get your fall booster (when the timing make sense).

"

 

[missy]

Adding some miscellaneous health issues here as well as I think some might find them informative and/or interesting

Non-Paxlovid Rebound​

by Kristen Monaco, Staff Writer, MedPage Today October 28, 2022


"
Outpatient COVID treatment with nirmatrelvir-ritonavir (Paxlovid) was 36% and 30% lower for Black and Hispanic patients compared with white patients, a CDC report found.

A high proportion of recovered COVID patients who didn't take nirmatrelvir-ritonavir also experience symptom rebound. (JAMA Network Open)

Continuing on a downward trend, yearly cancer death rates dropped by 2.1% from 2015 to 2019, with the steepest drops seen for lung cancer and melanoma. There was also an increase in pancreatic cancer survival, according to the National Cancer Institute's latest annual report.



Reversing recent trends, global tuberculosis (TB) cases rose by 4.5% from 2020 to 2021, the World Health Organization warned, including a 3% rise in drug-resistant TB.

The number of kids diagnosed with precocious puberty spiked during the pandemic -- but why? (The New Yorker)

An estimated 15% of people who test positive for SARS-CoV-2 develop long COVID. (JAMA Network Open)

Speaking of long COVID, the NIH chose nirmatrelvir-ritonavir to test first as a possible long COVID treatment in a randomized, placebo-controlled trial of 1,700 participants. (Reuters)

China is now rolling out its inhalable COVID-19 vaccine. (Reuters)

Walgreens said its will no longer judge pharmacist performance based on speed. (NBC News)

Should states funnel money received from opioid settlements back into addiction programs? (STAT)

Oregon could be the very first state to make affordable healthcare a human right after the measure got added to the November ballot. (AP)

Hear how a man with prostate cancer received a $73,812 bill for the two shots of a drug invented back in 1973. (Kaiser Health News)



Researchers say that paring imagery rehearsal therapy with an associated sound during REM sleep with targeted memory reactivation may be more effective for treating nightmare disorder. (Current Biology)

Shelves across the nation still haven't fully recovered from the baby formula shortage earlier this year. (NPR)

Following the Pennsylvania Senate debate on Tuesday, stroke survivors are finding kinship with Democratic candidate John Fetterman. (NBC News)

Yet another woman came forward claiming the Republican Georgia Senate nominee Herschel Walker pressured her into having an abortion. (NPR)

Genentech's injectable faricimab (Vabysmo) succeeded in two phase III studies, achieving non-inferiority compared with aflibercept injections for treating macular edema from branch and central retinal vein occlusion.

The nightly eye drop NVK002 was effective for treating myopia progression in children in the 3-year phase III CHAMP study, developer Vyluma reported.

With a phase III flop, GSK is tossing out plans to push forward with its investigational monoclonal antibody otilimab for moderate-to-severe arthritis.

An Iranian man referred to as the "world's dirtiest man" died at age 94 reportedly not long after his first bath in 60 years. (USA Today)
"

 

[missy]

"

Tuberculosis Deaths Rose During Pandemic, Reversing Years of Decline: WHO​

By Bhanvi Satija
October 28, 2022

(Reuters) - Global deaths from tuberculosis are estimated to have increased between 2019 and 2021, reversing years of decline as the COVID-19 pandemic severely derailed efforts to tackle the disease, the World Health Organization said on Thursday.
Global efforts to tackle deadly diseases such as AIDS, tuberculosis and malaria have suffered during the COVID-19 pandemic. The health crisis has particularly hit the response to TB and led countries to fall behind in meeting targets to curb the infectious disease.
WHO urged the world to apply lessons learnt from the pandemic to tuberculosis, which severely affects countries such as India, Indonesia, the Philippines and Pakistan.
"If the pandemic has taught us anything, it's that with solidarity, determination, innovation and the equitable use of tools, we can overcome severe health threats," WHO Director-General Tedros Adhanom Ghebreyesus said.

WHO’s annual TB report estimates that tuberculosis killed 1.6 million people in 2021, above the estimated 1.5 million deaths in 2020, and 1.4 million deaths in 2019. Deaths related to tuberculosis had fallen between 2005 and 2019.
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The report also warns that in the near future TB could replace COVID-19 to become the leading cause of death worldwide from a single infectious agent.
A recent report from Global Fund to Fight AIDS, Tuberculosis and Malaria shows that while the number of people reached with treatment and prevention efforts rebounded last year, the world is still not on track to defeat these killer diseases.
About 10.6 million people were infected with tuberculosis in 2021, an increase of 4.5% from 2020, according to the WHO report.

Under its "End TB Strategy", the WHO set a target of reducing TB deaths by 35% from 2015 to 2020, but the net reduction was 5.9% between 2015 and 2021.
(Reporting by Bhanvi Satija in Bengaluru; Editing by Manas Mishra and Maju Samuel)
"

 

[missy]

"

I am vaxxed and boosted … and have Covid​

I dodged Covid for 2.5 years and got my bivalent booster in September. Now I have Covid. How is that possible? Is it possible to know what variant I have? Dana, California First off, our reader deserves congratulations for making it so long without catching Covid. At this point, the vast majority of Americans have had the virus — some more than once. “While this bout with Covid may make you feel like your efforts were in vain, it's great that you protected yourself from repeated infections,” says Katrine Wallace, an epidemiologist at the University of Illinois at Chicago. “Each infection was a chance for severe disease in pre-vaccine days, and repeated infections increase the chances for long Covid and even, theoretically, creation of a new variant. Preventing all that was good!” That fresh booster, Wallace says, can’t totally prevent the spread of the virus but does lower the risk of developing a severe infection that results in hospitalization or death. While it’s exceedingly difficult for the reader to discover what variant she had, Wallace points out that the BA.4 and BA.5 omicron subvariants still account for about 70% of all infections detected by PCR testing. And nearly 90% of our US wastewater testing sites detected those same two variants last week. That’s good news, since that’s what the latest booster shots are designed to target. But new variants are always popping up. Researchers have sequenced samples and found new omicron subvariants, BQ.1 and BQ.1.1, that could be on the rise, says Wallace. They contain mutations that might allow them to circumvent some, but not all, of the protective defenses booster shots provide. In general, there’s probably much more Covid circulating than we realize, according to Jessica Justman, an infectious-diseases specialist and epidemiologist at the Columbia University Medical Center. “Even though the number of confirmed cases in the US is relatively low, the widespread use of self-testing rapid test kits means many cases are not confirmed, so the confirmed case count is definitely an underestimate,” she says. In New York, for example, researchers have found high levels of the virus in wastewater. That highlights the importance of getting vaccinated and boosted. And, says, Justman, if you do catch Covid, there are now many great treatment options, such as antiviral medications. — Kristen V. Brown

"

 

[missy]

"

I'm a Physician Battling Long COVID. I Can Assure You It's Real​

Monica Verduzco Gutierrez, MD
DISCLOSURES
October 27, 2022



One in 5. It almost seems unimaginable that this is the real number of people who are struggling with long COVID, especially considering how many people in the US have had COVID-19 at this point (more than 96 million). Yet I continue to hear of people who are struggling, and we continue to see a flood of people in the long COVID clinic. It isn't over, and long COVID is the new pandemic.

Even more unimaginable at this time is that it's happening to me. I've experienced not only the disabling effects of long COVID, but I've also seen, firsthand, the frustration of navigating diagnosis and treatment. It's given me a taste of what millions of other patients are going through.

Vaxxed, Masked, and (Too) Relaxed​

I caught COVID-19 (probably Omicron BA.5) that presented as sniffles, making me think it was probably just allergies. However, my resting heart rate was up on my Garmin watch, so of course I got tested and was positive.



With my symptoms virtually nonexistent, it seemed, at the time, merely an inconvenience because I was forced to isolate away from family and friends, who all stayed negative.

But 2 weeks later, I began to have urticaria — hives — after physical exertion. Did that mean my mast cells were angry? There's some evidence these immune cells become overactivated in some patients with COVID. Next, I began to experience lightheadedness and the rapid heartbeat of tachycardia. The tachycardia was especially bad any time I physically exerted myself, including on a walk. Imagine me — a lover of all bargain shopping — cutting short a trip to the outlet mall on a particularly bad day when my heart rate was 140 after taking just a few steps. This was orthostatic intolerance.




Then came the severe worsening of my migraines — which are often vestibular, making me nauseated and dizzy on top of the throbbing.

I was of course familiar with these symptoms, as professor and chair of the Department of Rehabilitation Medicine at the Joe R. and Teresa Lozano Long School of Medicine at University of Texas Health Science Center San Antonio. I developed a post-COVID recovery clinic to help patients.

So I knew about postexertional malaise (PEM) and postexertional symptom exacerbation (PESE), but I was now experiencing these distressing symptoms firsthand.
Clinicians really need to look for this cardinal sign of long COVID as well as evidence of myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). ME/CFS is marked by exacerbation of fatigue or symptoms after an activity that could previously be done without these aftereffects. In my case, as an All-American Masters miler with several marathons under my belt, running 5 miles is a walk in the park. But now, I pay for those 5 miles for the rest of the day on the couch or with palpitations, dizziness, and fatigue the following day. Busy clinic day full of procedures? I would have to be sitting by the end of it. Bed by 9 PM was not always early enough.

Becoming a Statistic​

Here I am, one of the leading experts in the country on caring for people with long COVID, featured in the national news and having testified in front of Congress, and now I am part of that lived experience. Me — a healthy athlete, with no comorbidities, a normal BMI, vaccinated and boosted, and after an almost asymptomatic bout of COVID-19, a victim to long COVID.

You just never know how your body is going to react. Neuroinflammation occurred in studies with mice with mild respiratory COVID, and could be happening to me. I did not want a chronic immune-mediated vasculopathy.

So, I did what any other hyperaware physician-researcher would do. I enrolled in the RECOVER trial — a study my own institution is taking part in and one that I recommend to my own patients.




I also decided that I need to access care and not just ignore my symptoms or try to treat them myself.

That's when things got difficult. There was a wait of at least a month to see my primary care provider — but I was able to use my privileged position as a physician to get in sooner.

My provider said that she had limited knowledge of long COVID, and she hesitated to order some of the tests and treatments that I recommended because they were not yet considered standard of care. I can understand the hesitation. It is engrained in medical education to follow evidence based on the highest-quality research studies. We are slowly learning more about long COVID, but acknowledging the learning curve offers little to patients who need help now.

This has made me realize that we cannot wait on an evidence-based approach — which can take decades to develop — while people are suffering. And it's important that everyone on the front line learn about some of the manifestations and disease management of long COVID.

I left this first physician visit feeling more defeated than anything and decided to try to push through. That, I quickly realized, was not the right thing to do.

So again, after a couple of significant crashes and days of severe migraines, I phoned a friend: Ratna Bhavaraju-Sanka, MD, the amazing neurologist who treats patients with long COVID alongside me. She squeezed me in on a non-clinic day. Again, I had the privilege to see a specialist most people wait half a year to see. I was diagnosed with both autonomic dysfunction and intractable migraine.

She ordered some intravenous (IV) fluids and IV magnesium that would probably help both. But then another obstacle arose. My institution's infusion center is focused on patients with cancer, and I was unable to schedule treatments there.

Luckily, I knew about the concierge mobile IV hydration therapy companies that come to your house — mostly offering a hangover treatment service. And I am thankful that I had the health literacy and financial ability to pay for some fluids at home.

On another particularly bad day, I phoned other friends — higher-ups at the hospital — who expedited a slot at the hospital infusion center and approval for the IV magnesium.


Thanks to my access, knowledge, and other privileges, I got fairly quick if imperfect care, enrolled in a research trial, and received medications. I knew to pace myself. The vast majority of others with long COVID lack these advantages.

The Patient With Long COVID​

Things I have learned that others can learn, too:

• Acknowledge and recognize that long COVID is a disease that is affecting 1 in 5 Americans who catch COVID. Many look completely "normal on the outside." Please listen to your patients.
• Autonomic dysfunction is a common manifestation of long COVID. A 10-minute stand test goes a long way in diagnosing this condition, according to this consensus statement from the American Academy of Physical Medicine and Rehabilitation. It is not just anxiety.
• "That's only in research" is dismissive and harmful. Think outside the box. Follow guidelines. Consider encouraging patients to sign up for trials.
• Screen for PEM/PESE, and teach your patients to pace themselves because pushing through it or doing graded exercises will be harmful.
• We need to train more physicians to treat postacute sequelae of SARS-CoV-2 infection (PASC) and other postinfectious conditions, such as ME/CFS.

If long COVID is hard for physicians to understand and deal with, imagine how difficult it is for patients with no expertise in this area.


It is exponentially harder for those with fewer resources, time, and health literacy. My lived experience with long COVID has shown me that being a patient is never easy. You put your body and fate into the hands of trusted professionals and expect validation and assistance, not gaslighting or gatekeeping.




Along with millions of others, I am tired of waiting.

 

[Daisys and Diamonds]

I'd rather have a lump of coal than Covid for Christmas

OPINION: There was a different sort of anticipation as I sat down to Christmas Day breakfast, and the RAT test confirmed the worst. Merry Covid Christmas.

www.stuff.co.nz