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What Is the Great Resignation? Definition, Causes & Impact

What Is the Great Resignation (AKA the Big Quit)? The Great Resignation—also commonly called the Big Quit or the Great Reshuffle—is an ongoing phenomenon…

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Employees have been leaving their jobs in search of better prospects at a higher rate than usual since the drop in the quit rate during the early stages of the COVID-19 pandemic. 

chayanuphol via Shutterstock; Canva

What Is the Great Resignation (AKA the Big Quit)?

The Great Resignation—also commonly called the Big Quit or the Great Reshuffle—is an ongoing phenomenon involving employees voluntarily leaving their jobs in unprecedented numbers. According to most, this phenomenon officially began around late 2020 or early 2021, after the quit rate (the number of monthly resignations divided by total employment) dropped sharply during the early stages of the COVID-19 pandemic due to a shortage of work as a result of large-scale shutdowns.

Once vaccines were rolled out and restrictions were loosened, many companies resumed business, and the number of job openings increased. At the same time, the quit rate nearly doubled from around 1.6% in early 2020 to about 3% by late 2021.

According to most pundits, this uptrend marked the start of the Big Quit, but the quit rate, which started being measured in 2000, tells a different story. A graph of the data shows a slow but steady uptrend since 2009 that is only interrupted by the work shortage caused by 2020’s shutdowns and resulting layoffs. When looked at from this perspective, the great resignation is a 10+ year-old phenomenon that has been gaining momentum for years.

Had it not been for the job shortage during the early stages of the COVID-19 pandemic, the quit rate may have simply continued to rise at a steady pace. 

Bureau of Labor and Statistics via St. Louis FRED

What Conditions Led to 2021’s Great Resignation?

During the COVID-19 pandemic, so-called “essential workers” (e.g., those who worked at grocery and retail stores, hospitals, and restaurants) found themselves under-compensated and overworked by their employers, many of whom didn’t seem eager to reward the significant risks they were taking with anything more than shallow praise for keeping essential services available to the public.

Essential workers were commonly lauded as heroes, but few received the hazard pay one would expect to accompany such work. Because of this, many frontline workers felt like expendable cogs in an uncaring machine, and as more jobs became available in late 2020 and early 2021, workers left the retail, restaurant, grocery, and hospitality industries in record numbers.

During the COVID-19 shutdowns, many companies whose businesses weren’t based around manufacturing or customer service shifted toward remote work for office-type employees, and the office-based workforce realized that this could become the norm. Why spend money and time commuting to an office when the same work could be done at home? In many cases, remote work also meant that money could be saved on child and pet care.

As vaccines became widely available and shutdowns subsided in late 2020 and early 2021, an abundance of job openings meant workers had more options, and due to the high cost of living and the lifestyle changes brought about by the pandemic, many weren’t satisfied with jobs that didn’t offer living wages or flexible work environments.

Money from unemployment and federal stimulus payments also meant that some workers had enough cash on hand to search more thoroughly for positions that met their requirements rather than accepting less-than-ideal work in order to survive after quitting.

These and other factors contributed to low unemployment and high labor demand, which made for an environment that favors workers’ ability to resign and seek new prospects.

What Reasons Did Workers Give for Quitting Their Jobs?

According to surveys created by the Pew Research Center, “low pay (63%), no opportunities for advancement (63%), and feeling disrespected at work (57%)” were the top three reasons respondents cited for leaving their jobs during this particular wave of resignations. The study also showed that younger adults and those with lower incomes quit at higher rates than older adults and those with higher incomes.

What Did People Do After Resigning?

So, where did all these people go after resigning from their jobs? The answer is unsurprising—they got other jobs. According to the Bureau of Labor and Statistics, the quit rate and swap rate had a correlation of close to 100 percent. Workers weren’t resigning just to resign; they were resigning in order to leverage their labor and land themselves jobs with better pay, better benefits, and more flexibility.

With unemployment low and labor demand high, companies had to compete with one another for job seekers by providing incentives. According to the New York Times, “When workers switched jobs, they often increased their pay. Wages grew nearly 10 percent in leisure and hospitality [from May 2021 to May 2022] and more than 7 percent in retail,” two of the industries most heavily hit by the Big Quit.

In some cases, non-resigning workers were also able to leverage this shift in the labor market by demanding better pay and more flexible conditions. For many office workers, this often meant the ability to start (or keep) working remotely.

Do Workers Have More Bargaining Power Than They Did Before 2020?

In general, the conditions that existed during the Great Reshuffle shifted a degree of bargaining power from employers to workers. But will it stay that way? In general, the more demand there is for labor, and the lower the unemployment rate, the more bargaining power workers (and job seekers) have.

Interestingly, this shifting power dynamic seemed to bring about a resurgence in the labor movement, as a wave of unionization efforts followed the Great Resignation. These efforts were not, in most cases, welcomed by large employers, many of whom—such as Amazon and Starbucks—invested considerable capital into union-busting efforts and other (sometimes illegal) forms of retaliation. Nevertheless, unionization efforts continued. By May of 2022, 100 Starbucks stores had voted in favor of unionization.

Concurrently, many workers expressed their mutual solidarity in online communities. A subreddit called r/antiwork grew by over 900,000 members in 2021 and drew the ire of Fox News, a network that tends to be associated with right-wing, anti-labor-movement politics. Within the r/antiwork community, workers not only shared stories about low pay, horrible working conditions, and villainous bosses—they also shared legal information about workers’ rights and the unionization process.

Members encouraged each other to be transparent with their coworkers about pay and reminded one another that the prohibition of discussions of pay in the workplace by bosses and managers is against the law. The community continues to grow, and as of mid-2022, it had over 2 million members.

Is the Great Resignation Still Occurring?

The quit rate has fallen somewhat from its November 2021 peak, but as of late June 2022, it remains relatively high at about 2.9%. Unionization efforts are still on the rise, and workers are learning about their rights and collective power.

Given the Great Resignation’s generally upward trajectory since 2009, and the resurgence of the labor movement, it doesn’t appear as if the Big Quit is going anywhere anytime soon. According to Katherine Ross’ interview with ZipRecruiter CEO Ian Siegl, the “post-pandemic job-seeker” is here to stay. 

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Economics

Catalytic Investment to Improve Community Health Care for Millions Across Africa

Catalytic Investment to Improve Community Health Care for Millions Across Africa
PR Newswire
GENEVA, Aug. 8, 2022

The Global Fund collaborates with the Johnson & Johnson Foundation and the Skoll Foundation to Launch the Africa Frontline First C…

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Catalytic Investment to Improve Community Health Care for Millions Across Africa

PR Newswire

The Global Fund collaborates with the Johnson & Johnson Foundation and the Skoll Foundation to Launch the Africa Frontline First Catalytic Fund

  • Private sector investments to the Global Fund's Africa Frontline First Catalytic Fund from the Johnson & Johnson Foundation and the Skoll Foundation totaling US$ 25 million.
  • The Global Fund to Fight AIDS, TB and Malaria intends to further match this commitment by at least with 1:1.
  • Designed in partnership with the Africa Frontline First Initiative, the Africa Frontline First Catalytic Fund (AFF-CF) will accelerate scale up of community health services in up to 10 African countries.
  • The Catalytic Fund seeks to mobilize at least $100 million to improve community health systems that are providing essential medical care for up to 130 million people.
  • Investing in frontline community health workers can generate a return of up to 10:1 when considering the improved economic, health, and social outcomes of community health workers.

GENEVA, Aug. 8, 2022 /PRNewswire/ -- Today the Global Fund to Fight AIDS, TB and Malaria is announcing a crucial new catalytic fund to support community health workers across up to 10 African countries. The Africa Frontline First Catalytic Fund (AFF-CF) will provide financing to accelerate and sustain the scale up of frontline community health workers, the backbone of community health services.

The Global Fund warmly welcomes the first investments to the Africa Frontline First Catalytic Fund from the Johnson & Johnson Foundation and the Skoll Foundation totaling US $25 million. The Global Fund intends to match these and other investments to bolster support to and domestic financing for community health workers.

These pledges come ahead of the Global Fund's Seventh Replenishment, which aims to raise US $18 billion to fund its next three-year cycle of grants. The Global Fund estimates that the funding of US $18 billion would save 20 million lives, while strengthening health and community systems to reinforce pandemic preparedness.

"For the first time in 20 years, many countries have seen HIV, TB and malaria cases worsen and community health workers are at the forefront of fighting these diseases. This is a unique moment for leaders to join forces and invest in the people and structures that will fight pandemics, infectious diseases, and other health threats, now and in the future" said Peter Sands, Executive Director of The Global Fund.

A professionalized workforce of community health workers, who work hand in hand with communities, is key to responding to future outbreaks and making gains on longstanding priorities. The Global Fund applauds these initial pledges from the Johnson & Johnson Foundation and the Skoll Foundation, but much more financial investment is needed to unlock the full potential and to ensure people access to professionalized, trained, compensated, and integrated community health workers.

The Africa Frontline First Catalytic Fund will help ensure that up to 10 African countries accelerate progress and improve health care delivered at the community level, as well as crucially ensure the women, who make up the large proportion of community health workers, are properly paid for their work. The Catalytic Fund will combine coordinated technical assistance and implementation funding, as well as investments to scale financing, employ digital tools, increase the availability of essential life-saving commodities, and better integrate community health workers within the overall health system.

"Health workers are the cornerstone of care. By training, empowering, and integrating community health workers into existing health systems it's possible to extend care and reduce the burden of disease for millions of people." said Joaquin Duato, CEO of Johnson & Johnson. "The Johnson & Johnson Foundation committed $15 million to the Africa Frontline First Catalytic Fund to ensure delivery of effective, efficient, and equitable care at the frontlines."

The Global Fund Catalytic Fund approach has already shown the power of leveraging philanthropic funding. For example, support from the Children's Investment Fund Foundation for HIV self-testing has increased funding fivefold in two years and increased HIV self-test procurement from thousands to millions in the five countries where it works.

"On the frontlines of pandemic response and prevention, community health workers are critical to bringing essential healthcare to the last mile," said Don Gips, CEO of the Skoll Foundation. "The Africa Frontline First Catalytic Fund brings the power of social innovators like the Financing Alliance for Health and Last Mile Health together with the strength of the Global Fund to ensure that community health workers are paid, trained, and equipped to maintain essential services and lead responses to COVID-19, Ebola, and other outbreaks."

This catalytic investment is a first step towards a broader shared ambition to scale community health, contributing to expanding universal health coverage. As part of this effort,

Africa Frontline First is collaborating with the COVID-19 Commission, which supports H.E. President Ramaphosa in his role as the African Union Champion on COVID-19. In line with the African Union's New Public Health Order, this collaboration pursues the AU's broader target of deploying 2 million community health workers by 2030.

More than 85% of community health workers in Africa, the majority of whom are women, are not paid for their work.  Experience shows that professional community health workers - who are paid, trained, and supervised - are best equipped to provide essential health services in their communities, even amid great challenges.

"In Liberia and around the world, we have seen the power of community health workers to deliver essential care in rural and remote communities - and to maintain that care during crises like the Ebola epidemic and the COVID-19 pandemic," said Her Excellency Ellen Johnson Sirleaf, Nobel Peace Prize recipient and former President of Liberia. "The Africa Frontline First Catalytic Fund is a unique opportunity to invest in those health workers and catalyze real change, creating a healthier and safer world for all."

The Global Fund is a worldwide movement to defeat HIV, TB and malaria and ensure a healthier, safer, more equitable future for all. We raise and invest more than US$4 billion a year to fight the deadliest infectious diseases, challenge the injustice which fuels them and strengthen health systems in more than 100 of the hardest hit countries. Since the beginning of the COVID-19 pandemic, we have invested an additional US$4.3 billion to fight the new pandemic and reinforce systems for health. We unite world leaders, communities, civil society, health workers and the private sector to find solutions that have the most impact, and we take them to scale worldwide. Since 2002, the Global Fund has saved 44 million lives.

Africa Frontline First is a collaborative effort by the Financing Alliance for Health, Last Mile Health, the Community Health Acceleration Partnership, and Community Health Impact Coalition under the championship of President Ellen Johnson Sirleaf.

Information on the work of the Global Fund is available at www.theglobalfund.org
Information on Africa Frontline First is available at  www.africafrontlinefirst.org

Follow the Global Fund on Twitter: http://twitter.com/globalfund
Follow Africa Frontline First on Twitter: https://twitter.com/frontline1st

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View original content:https://www.prnewswire.com/news-releases/catalytic-investment-to-improve-community-health-care-for-millions-across-africa-301601401.html

SOURCE The Global Fund

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Stocks for a recession: which companies have historically done well during recessions or are likely to this time?

Last week the Bank of England forecast a recession starting this autumn that it now expects to be deeper and longer than previously assumed. It also expects…

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Last week the Bank of England forecast a recession starting this autumn that it now expects to be deeper and longer than previously assumed. It also expects inflation to hit 13% by the end of the year just months after reassuring that it didn’t expect more than modestly high figures.

Having belatedly acknowledged the extent of the inflation problem, admittedly exacerbated by the impact on energy and food prices the war in Ukraine has had, the UK’s central bank’s nine-member Monetary Policy Committee voted to raise interest rates. Thursday’s 0.5 percentage points rise, which took the BoE’s base rate to 1.75%, was the biggest single increase in 27 years.

The European Central Bank and USA’s Federal Reserve have also taken aggressive measures on rates, with the former also raising rates by 0.5% to 0%. It was the ECB’s first rates rise in 11 years. The Fed went even further, raising rates for the fourth and largest time this year with a 0.75 percentage points hike to between 2.25% and 2.5%.

Aggressive interest rate hikes alongside high levels of inflation tend to result in recession with the combination referred to as stagflation. With inflation expected to remain high next year and not dropping back towards the target 2% before 2023, we could be in for an extended period of recession.

Why stock markets fall during a recession but not all stocks do

Stock markets historically do badly during recessions for the simple reason they are a proxy for the economy and economic activity. When economic activity drops, people and companies have less money or are worried about having less money, so they spend less and companies earn less. Investors also become less optimistic about their prospects and valuations drop.

But the kind of drop in economic activity that leads to recessions is not evenly distributed across all areas of an economy. When consumers cut back on spending, they typically choose to sacrifice some things and not others, rather than applying an even haircut across all costs. And there are goods and services that people spend more on rather than less when tightening their belts.

So while the net impact of a recession has always historically been the London Stock Exchange and other major international stock markets losing market capitalisation, or value, that doesn’t mean all the stocks that constitute them go down. Some go down by more than others. And some stocks grow in value because the companies sell the categories of goods and services people spend more on when they are either poorer or worried about becoming poorer.

Should we be investing “for” a recession?

This surely means all investors need to do to mitigate against a recession is to sell out of the stocks that do badly during an economic slump and buy into those that do well? In theory, yes. In practice, doing that successfully would mean being sure a recession will take place some time before it becomes a reality and timing its onset, then the subsequent recovery, well.

That is of course far easier said than done which is why even professional fund managers don’t attempt the kind of comprehensive portfolio flip that would involve. Some investors will make big bets on events like the onset of a recession or inflation spiralling out of control.

They are the kind of bets that make for dramatic wins like those portrayed in the Hollywood film The Big Crash, which tells the story of a group of traders who predicted and bet big on the 2007 subprime mortgage implosion that triggered the international financial crisis. But as the film relies on for its dramatic tension, the big winners of The Big Crash very nearly got their timing wrong. Another few days and they would have been forced to close their positions just before market conditions turned in their favour and lost everything.

The reality is the big, risky bets that result in spectacular investment wins when they come off are usually far more likely to go wrong than right. Which is why regular investors, rather than high risk traders using leverage, shouldn’t take them. At least not with their main investment portfolio if they don’t have the luxury of being able to justify setting aside 10% to 20% of capital for highr isk-high reward bets.

If you have a well-balanced investment portfolio with a long term horizon and you are happy with the overall quality of your investments, you may choose to do nothing at all to mitigate against the recession that is almost certainly coming. If you have ten years or more until you expect to start drawing down an income from your portfolio, your investments should have plenty of time to recover from this period.

But if you do want to rebalance because you feel your portfolio is generally too heavily weighted towards the kind of growth stocks particularly vulnerable to inflation, higher interest rates and recession, you might want to consider rotating some of your capital into the kind of stocks that might do well in a recession.

How to pick stocks that will do well in a recession?

There are two ways to highlight stocks that might do well in a recession. The first is the most obvious and simplest approach – look at which did well in previous recessions. We had a very brief recession at the start of the Covid-19 pandemic and a much more significant one in 2008/09 in the wake of the international financial crisis. Which companies did well over those periods?

The second approach is to add a layer of complexity into the equation and consider how and why the coming recession might differ from the two most recent historical examples. The 2020 recession was extremely unusual in its brevity. Within a couple of months, stock markets were soaring again as people under quarantine and social distancing restrictions spent more in the digital economy and generally on services and products to enhance their experience being couped up at home.

The 2008/09 recession was also different because it was caused by a systemic failure in the financial sector. Unemployment leapt which is not expected to happen this time around with an especially tight labour market one result of the combination of the pandemic and Brexit. Many households also have higher levels of savings built up during the pandemic which a significant number of analysts believe is softening the impact of inflation.

While there are likely to be constants throughout recessions, there are also differences that should be taken into account. Normally energy companies do badly during a recession as lower economic activity means less energy being used. But energy companies are currently posting record profits because of sky-high energy prices which are one of the major factors behind the expected recession. They should continue to do well while the recession lasts as energy prices dropping again is likely to be one of the catalysts behind the recovery.

The online trading company eToro recently published two baskets of “recession winning stocks” – one made up of Wall Street-listed companies and the other companies listed in the UK. The stocks in each basket were selected because they were the biggest gainers during the last two recessions. Interestingly, they also did well during the intervening period between 2009 and 2020, as well as in the aftermath of the coronavirus crash.

The portfolio of US stocks beat the S&P 500 index of large American businesses by 60 percentage points through the financial crisis between 2007 and 2009 and by 9 percentage points during the Covid crisis in 2020.

The portfolio of UK stocks beat FTSE-100 by 35 percentage points during the financial crisis and by 17 percentage points in the Covid crash. Since 2007, the US portfolio has gained 834%, more than twice the return of the Nasdaq and about five times that of the S&P 500. The UK portfolio’s 129% return is eight times more than the FTSE 100’s, excluding dividends.

eToro says:

“Well represented segments included discount and everyday-low-price retailers as consumers trade down, like Walmart (WMT), Ross Stores (ROST) and Dollar Tree (DLTR).”

“Fast food McDonalds (MCD) is related. Similarly, home DIY, like Home Depot (HD) Lowe’s (LOWE), and auto repair parts stocks Autozone (AZO) and O’Reilly (ORLY). Health care and big biotech is well-represented as inelastic non-discretionary purchases, like Abbott (ABT), Amgen (AMGN), Vertex (VRTX).”

“Also, domestic comforts from toys (Hasbro, HAS) to candy (Hershey, HSY), and getting more from your money and tax (H&R Block, HRB), and educating yourself (2U, TWOU).”

The UK portfolio included the drug makers AstraZeneca and GlaxoSmithKline, which did well because spending money on healthcare and medicines is essential and families don’t tend to cut back even when struggling financially.

The cigarette makers British American Tobacco and Imperial Brands also don’t usually see any downturn in demand because they benefit from a customer base addicted to their products. Both companies pay high and rising dividends. Consumer goods firms such as Unilever and Premier Foods also typically do well because they own strong brands that people bought even after price rises have been passed on.

Proactive Investor also picks out a range of London-listed stocks it expects to do well over the next year or so. In the energy sector that is doing so well at the moment it highlights Harbour Energy as a “core sector stock” and Diversified Energy Company as having “one of the lowest-risk free cash flow profiles in the sector”, while Energean (a client) provides “excellent visibility on multi-decade cash flows”.

Another difference to recent recessions could be how miners do during the one expected from autumn. Normally lower economic activity reduces for demand for commodities but the sector is also facing supply constraints that should see prices supported or rebound quickly.

Copper, mineral sands and diamonds look among the commodities most constrained in terms of supply, with limited supply growth under development. Mining and commodity stocks to look at are suggested as:

“Atalaya Mining (AIM:ATYM, TSX:AYM), Central Asia Metals, Kenmare Resources, Petra Diamonds and Antofagasta, with Tharisa PLC (LSE:THS, JSE:THA) tagged on as platinum group output to be in focus as automotive sales recover.”

“Gold stocks are seen as outperforming the market during the pullback phase, as in March 2020 and in the initial stages of a rebound, with top picks currently Pan African Resources PLC (AIM:PAF, OTCQX:PAFRY, JSE:PAN, OTCQX:PAFRF), Pure Gold Mining Inc (TSX-V:PGM, LSE:PUR, OTC:LRTNF), Wheaton Precious Metals and Yamana Gold (TSX:YRI, LSE:AUY).”

Credit Suisse has also picked out stocks that have historically outperformed during recessions, highlighting:

“London Stock Exchange Group PLC (LSE:LSEG), RELX PLC (LSE:REL), Experian (LSE:EXPN) PLC, Microsoft Corporation (NASDAQ:MSFT) and Visa Inc (NYSE:V).”

Don’t panic

While there is nothing wrong with doing some periodic portfolio rebalancing and potentially rotating more assets into stocks seen as likely to thrive in a recession, don’t panic. Recessions have always come and gone as part of the economic cycle and stock markets traditionally go on to greater heights during the subsequent recovery.

That means the chances are your portfolio will regain its losses and add new gains over the years ahead. Buying cheap growth stocks seen as likely candidates to flourish again during the recovery could be seen as just as sensible a tactic as rotating into recession-proof stocks. But if you do decide to reposition to some extent, look for stocks that have not only historically done well during recessions, or could be expected to during this one ahead, but are also healthy companies you would expect to keep doing well when markets recover. Then your success won’t come down to the fickle fate of whether or not you get your timing right.

The post Stocks for a recession: which companies have historically done well during recessions or are likely to this time? first appeared on Trading and Investment News.

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Fatigue, headache among top lingering symptoms months after COVID

AUGUSTA, Ga. (Aug. 8, 2022) – Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from…

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AUGUSTA, Ga. (Aug. 8, 2022) – Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

Credit: Augusta University

AUGUSTA, Ga. (Aug. 8, 2022) – Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

Muscle aches, cough, changes in smell and taste, fever, chills and nasal congestion were next in the long line of lingering symptoms.

“Our results support the growing evidence that there are chronic neuropsychiatric symptoms following COVID-19 infections,” Medical College of Georgia investigators write in the journal ScienceDirect

“There are a lot of symptoms that we did not know early on in the pandemic what to make of them, but now it’s clear there is a long COVID syndrome and that a lot of people are affected,” says Dr. Elizabeth Rutkowski, MCG neurologist and the study’s corresponding author.

The published study reports on preliminary findings from the first visit of the first 200 patients enrolled in the COVID-19 Neurological and Molecular Prospective Cohort Study in Georgia, or CONGA, who were recruited on average about 125 days after testing positive for the COVID-19 virus.

CONGA was established at MCG early in the pandemic in 2020 to examine the severity and longevity of neurological problems and began enrolling participants in March 2020 with the ultimate goal of recruiting 500 over five years.

Eighty percent of the first 200 participants reported neurological symptoms with fatigue, the most common symptom, reported by 68.5%, and headache close behind at 66.5%. Just over half reported changes in smell (54.5%) and taste (54%) and nearly half the participants (47%) met the criteria for mild cognitive impairment, with 30% demonstrating impaired vocabulary and 32% having impaired working memory.

Twenty-one percent reported confusion, and hypertension was the most common medical condition reported by participants in addition to their bout with COVID-19.

No participants reported having a stroke, weakness or inability to control muscles involved with speaking, and coordination problems were some of the less frequently reported symptoms.

Twenty-five percent met the criteria for depression, and diabetes, obesity, sleep apnea and a history of depression were associated with those who met the criteria. Anemia and a history of depression were associated with the 18% who met the objective criteria for anxiety.

While the findings to date are not surprising and are consistent with what other investigators are finding, Rutkowski says the fact that symptoms reported by participants often didn’t match what objective testing indicated, was surprising. And, it was bidirectional.

For example, the majority of participants reported taste and smell changes, but objective testing of both these senses did not always line up with what they reported. In fact, a higher percentage of those who did not report the changes actually had evidence of impaired function based on objective measures, the investigators write. While the reasons are not certain, part of the discrepancy may be a change in the quality of their taste and smell rather than pure impaired ability, Rutkowski says.

“They eat a chicken sandwich and it tastes like smoke or candles or some weird other thing but our taste strips are trying to depict specific tastes like salty and sweet,” Rutkowski says. Others, for example, may rely on these senses more, even when they are preparing the food, and may be apt to notice even a slight change, she says.

Either way, their data and others suggest a persistent loss of taste and smell following COVID-19, Rutkowski and her colleagues write.

Many earlier reports have been based on these kinds of self-reports, and the discrepancies they are finding indicate that approach may not reflect objective dysfunction, the investigators write.

On the other hand, cognitive testing may overestimate impairment in disadvantaged populations, they report.

The first enrollees were largely female, 35.5% were male. They were an average of 44.6 years old, nearly 40% were Black and 7% had been hospitalized because of COVID-19. Black participants were generally disproportionately affected, the investigators say.

Seventy-five percent of Black participants and 23.4% of white participants met criteria for mild cognitive impairment. The findings likely indicate that cognitive tests assess different ethnic groups differently. And, socioeconomic, psychosocial (issues like family problems, depression and sexual abuse) and physical health factors generally may disproportionately affect Black individuals, the investigators write. It also could mean that cognitive testing may overestimate clinical impairment in disadvantaged populations, they write.

Black and Hispanic individuals are considered twice as likely to be hospitalized by COVID-19 and ethnic and racial minorities are more likely to live in areas with higher rates of infection. Genetics also is a likely factor for their increased risk for increased impact from COVID, much like being at higher risk for hypertension and heart disease early and more severely in life.

A focus of CONGA is to try to better understand how increased risk and effects from COVID-19 impact Blacks, who comprise about 33% of the state’s population.

A reason fatigue appears to be such a major factor among those who had COVID-19 is potentially because of levels of inflammation, the body’s natural response to an infection, remain elevated in some individuals. For example, blood samples taken at the initial visit and again on follow up showed some inflammatory markers were up and stayed up in some individuals.

These findings and others indicate that even though the antibodies to the virus itself may wain, persistent inflammation is contributing to some of the symptoms like fatigue, she says. She notes patients with conditions like multiple sclerosis and rheumatoid arthritis, both considered autoimmune conditions that consequently also have high levels of inflammation, also include fatigue as a top symptom.

“They have body fatigue where they feel short of breath, they go to get the dishes done and they are feeling palpitations, they immediately have to sit down and they feel muscle soreness like they just ran a mile or more,” Rutkowski says.

“There is probably some degree of neurologic fatigue as well because patients also have brain fog, they say it hurts to think, to read even a single email and that their brain is just wiped out,” she says. Some studies have even shown shrinkage of brain volume as a result of even mild to moderate disease. 

These multisystem, ongoing concerns are why some health care facilities have established long COVID clinics where physicians with expertise in the myriad of problems they are experiencing gather to see each patient.

CONGA participants who reported more symptoms and problems tended to have depression and anxiety.

Problems like these as well as mild cognitive impairment and even impaired vocabulary may also reflect the long-term isolation COVID-19 produced for many individuals, Rutkowski says.

“You are not doing what you would normally do, like hanging out with your friends, the things that bring most people joy,” Rutkowski says. “On top of that, you may be dealing with physical ailments, lost friends and family members and loss of your job.”

For CONGA, participants self-report symptoms and answer questions about their general state of health like whether they smoked, drank alcohol, exercised, and any known preexisting medical conditions. But they also receive an extensive neurological exam that looks at fundamentals like mental status, reflexes and motor function. They also take established tests to assess cognitive function with results being age adjusted. They also do at-home extensive testing where they are asked to identify odors and the ability to taste sweet, sour, bitter, salty, brothy or no taste. They also have blood analysis done to look for indicators of lingering infection like those inflammatory markers and oxidative stress.

Neuropsychiatric symptoms are observed in the acute phase of infection, but there is a need for accurate characterization of how symptoms evolve over time, the investigators write.

And particularly for some individuals, symptoms definitely linger. Even some previously high-functioning individuals, who normally worked 80 hours a week and exercised daily, may find themselves only able to function about an hour a day and be in the bed the remainder, Rutkowski says.

The investigators are searching for answers to why and how, and while Rutkowski says she cannot yet answer all their questions, she can tell them with certainty that they are not alone or “crazy.”  

One of the best things everyone can do moving forward is to remain diligent about avoiding infection, including getting vaccinated or boosted to help protect your brain and body from long COVID symptoms and help protect others from infection, Rutkowski says. There is evidence that the more times you are infected, the higher the risk of ongoing problems.

Rutkowski notes that their study findings may be somewhat biased toward high percentages of ongoing symptoms because the study likely is attracting a high percentage of individuals with concerns about ongoing problems.

SARS-CoV-2 is thought to have first infected people in late 2019 and is a member of the larger group of coronaviruses, which have been a source of upper respiratory tract infections, like the common cold, in people for years.

At least part of the reason SARS-CoV-2 is believed to have such a wide-ranging impact is that the virus is known to attach to angiotensin-converting enzyme-2, or ACE2, which is pervasive in the body. ACE2 has a key role in functions like regulating blood pressure and inflammation. It’s found on neurons, cells lining the nose, mouth, lungs and blood vessels, as well as the heart, kidneys and gastrointestinal tract. The virus attaches directly to the ACE2 receptor on the surface of cells, which functions much like a door to let the virus inside.

Experience and study since COVID-19 started both indicate immediate neurological impact can include loss of taste and smell, brain infection, headaches and, less commonly, seizures, stroke and damage or death of nerves. As time has passed, there is increasing evidence that problems like loss of taste and smell, can become chronic, as well as problems like brain fog, extreme fatigue, depression, anxiety and insomnia, the investigators write. Persistent conditions including these and others are now referenced as “long Covid.”

The research was supported by funding from the National Institute of Neurological Disorders and Stroke and philanthropic support from the TR Reddy Family Fund.

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