For Bereaved Families, Virus Toll Includes Suicides by the Young

Families of young people who died during the pandemic are haunted by questions over whether lockdowns played a role. Here’s the latest on Covid-19.,

LiveUpdated March 27, 2021, 1:49 p.m. ETMarch 27, 2021, 1:49 p.m. ET

Newly approved vaccine production plants in the Netherlands, Switzerland and Germany will add to Europe’s lagging supplies. Special training offers Covid survivors a route back to a sense of smell.

Annie Arkwright, near her home in Shropshire, England. She lost her 19-year-old daughter, Lily, to suicide in October. “Lockdown put Lily in physical and emotional situations she would never have in normal times,” Ms. Arkwright said.Credit…Andrew Testa for The New York Times

More than 2.7 million people have died from the coronavirus, a tangible count of the pandemic’s cost. But as more people are vaccinated, and communities open up, there is a tally that experts say is harder to track: the psychological toll of months of isolation and global suffering, which for some has proved fatal.

There are some signs indicating a widespread mental health crisis. Japan saw a spike in suicide among women last year, and in Europe, mental health experts have reported a rise in the number of young people expressing suicidal thoughts. In the United States, many emergency rooms have faced surges in admissions of young children and teenagers with mental health issues.

Mental health experts say prolonged symptoms of depression and anxiety may prompt risky behaviors that lead to self-harm, accidents, or even death, especially among young people.

Some intellectuals, like the Israeli historian Yuval Noah Harari, have asked the authorities to weigh the risks of depression if they impose new virus restrictions. And public health officials in some areas that have seen a surge of adolescent suicides have pushed for schools to reopen, although researchers say it is too early to conclusively link restrictions to suicide rates.

In Europe, with the crippled economy and the aftermath of the restrictions, the psychological fallout of the pandemic could unfold for months, or even years, public health officials say, with young people among the most affected.

Bereaved families of young people who have died during the pandemic are haunted by questions over whether lockdowns — which not only shut stores and restaurants but required people to stay home for months — played a role. They are calling for more resources for mental health and suicide prevention.

Lily Arkwright, a 19-year-old history student at Cardiff University in Wales, was self-confident, outgoing and charismatic in public, her friends and family said, but as she went back to school in September, she began to struggle with the effects of lockdown. She died by suicide in October.

“Lockdown put Lily in physical and emotional situations she would never have in normal times,” said her mother, Annie Arkwright.

“It’s OK for a young child to fall over and let their parents know that their knee hurts,” Ms. Arkwright said. “This same attitude needs to be extended to mental health.”

A line for vaccines in Munich, earlier this week. Only about 10 percent of Europeans have received a first dose.
A line for vaccines in Munich, earlier this week. Only about 10 percent of Europeans have received a first dose.Credit…Laetitia Vancon for The New York Times

The European Union’s stumbling Covid-19 vaccination drive, badly shaken by the recent AstraZeneca safety scare, got a boost Friday from the European Medicines Agency, which approved new AstraZeneca, Pfizer-BioNTech and Moderna vaccine production sites.

The agency, an arm of the European Union and Europe’s top drug regulator, approved sites in the Netherlands, Germany and Switzerland. It also loosened regulations for how long the Pfizer vaccine must be stored at ultralow temperatures.

The moves could speed up the Continent’s lagging vaccine production and distribution, which have been plagued by delays and setbacks.

Though the European Union is flush with cash, influence and negotiating heft, only about 10 percent of its citizens have received a first dose, compared with 26 percent in the United States and 44 percent in Britain. The bloc of 27 nations was comparatively slow to negotiate contracts with drugmakers, and regulators were cautious and deliberative in approving some vaccines. And it has been stymied by supply disruptions and shortages.

Europe also experienced a scare over the safety of the AstraZeneca vaccine and distribution in several countries was temporarily halted. Most of those countries have resumed using it, after the E.M.A. vouched for its safety, but public confidence in the shot has been severely undermined.

The agency said a new warning label would be added to the vaccine so that people in the medical community could watch for rare complications that could lead to blood clots and brain bleeds.

Trust in the AstraZeneca vaccine is essential to fighting the pandemic worldwide. The shot is more easily stored and less expensive than Pfizer’s or Moderna’s, and for now, it is sold without the goal of earning a profit.

The European Union has exported more vaccine doses than it has administered. On Wednesday, the it revealed emergency legislation that would curb exports of Covid-19 vaccines manufactured in its countries for the next six weeks.

According to a tweet by Ursula von der Leyen, president of the European Commission, the European Union has shipped out 77 million doses since early December, 88 million will have been distributed internally by the end of the week, and 62 million shots have been administered within the member nations.

“I can’t explain to European citizens why we are exporting millions of vaccine doses to countries that are producing vaccines themselves and aren’t sending us anything back,” Ms. von der Leyen, said last week.

The police in Hyderabad, India, have attributed five of the city's suicides to lenders that prey on working-class Indians.
The police in Hyderabad, India, have attributed five of the city’s suicides to lenders that prey on working-class Indians.Credit…Saumya Khandelwal for The New York Times

These lenders don’t require credit scores or visits to a bank. But they charge high costs over a brief period. They also require access to a borrower’s phone, siphoning up contacts, photos, text messages, even battery percentage.

Then they bombard borrowers and their social circles with pleas, threats and sometimes fake legal documents threatening dire consequences for nonpayment.

In conservative, tightly knit communities, such loss of honor can be devastating.

“If I am labeled a fraud in front of everyone, my self-respect is gone, my honor is gone,” Kiran Kumar, a 28-year-old cement salesman, said in an interview. “What is left?”

Mr. Kumar initially borrowed about $40 from a lender through an online app to supplement his $200-a-month salary. But he couldn’t pay the mounting fees and interest, so he borrowed from others. Eventually, he owed roughly $4,000.

One morning, he said, the harassing calls began soon after sunrise, with the lenders threatening to make his problems public. Mr. Kumar recalls remaining in bed and, for hours, thinking about how he was going to end his life.

The authorities in India are increasingly worried that many more victims like Mr. Kumar may be out there.

The investigations are raising alarms in India over the vulnerability of a population of 1.3 billion people who are still getting accustomed to digital payments.

The apps being used to take advantage of Indians also speak to the global nature of online fraud. Many of the companies use techniques that flourished in China two years ago before the authorities there shut them down.

In India, one police investigation alone in the city of Hyderabad has mapped out about 14 million transactions across the country worth $3 billion over about six months. India’s central bank and national authorities are now investigating.

“It is becoming difficult for us to count the zeros,” said Avinash Mohanty, the joint commissioner of police in Hyderabad.

Credit…Patricia Voulgaris for The New York Times

It’s called smell training, and it is suddenly in big demand.

According to one study, as many as 77 percent of those people who have had Covid-19 were estimated to have some form of smell loss as a result of their infections.

People with smell loss may also develop parosmia, a disturbing disorder that causes previously normal odors to be experienced as unpleasant.

Several studies have demonstrated that smell training can help people who have lost some or all of their senses of smell to other viral illnesses like sinus infections. So while there are no robust studies examining the efficacy of the training among Covid survivors, it is still widely considered the best option for them.

Smell training is somewhat akin to physical therapy for your nose: tedious and repetitive. It involves sniffing several potent scents twice a day, sometimes for months, to stimulate and restore the olfactory system — or at the very least to help it function better.

“It’s not a quick fix,” said Chrissi Kelly, a member of the Global Consortium for Chemosensory Research and the founder of AbScent, a nonprofit group based in England and Wales that offers support and education to people around the world who have smell disorders. “You have to keep up with it.”

If it has been a couple of weeks since you lost your sense of smell and it hasn’t started to come back, then it makes sense to start smell training. When the sense starts to come back, it might happen gradually rather than all at once. At first, scents might seem distorted or foul.

Scientists are still learning about all of the mechanisms by which the coronavirus affects the olfactory system, but they believe parosmia occurs because the neural pathways from the nose to the brain have been disrupted, “kind of like a telephone operator from the 1950s connecting the wrong party to another line,” said Pamela Dalton, a faculty member at the Monell Chemical Senses Center, a nonprofit research institute in Philadelphia.

For most people, parosmia is a symptom of recovery, and that’s why experts believe smell training can be beneficial as you continue to heal.

People waiting to receive shots of Russia's Sputnik V vaccine in Buenos Aires in February. Argentina has decided to delay second doses of this and other vaccines to focus on first shots.
People waiting to receive shots of Russia’s Sputnik V vaccine in Buenos Aires in February. Argentina has decided to delay second doses of this and other vaccines to focus on first shots.Credit…Matias Baglietto/Reuters

BUENOS AIRES — Argentina is delaying the administration of the second dose of Covid-19 vaccines for three months in an effort to ensure that as many people as possible get at least one dose amid a sluggish vaccination drive.

The move “seeks to vaccinate the largest number of people possible with the first dose to maximize the benefits of vaccination and diminish the impact of hospitalizations and mortality,” the government said in announcing the decision on Friday.

The country has been applying Russia’s Sputnik V, China’s Sinopharm and Covishield, the Indian version of the AstraZeneca vaccine.

Since its vaccination campaign began in December, Argentina, a country of 45 million people, says it has administered a total of 3.55 million doses of vaccine, including 658,426 who have received the two doses called for in the protocols for all three vaccines.

Several countries are considering delaying second doses, including Britain, which pursued a plan to separate doses by up to three months. And federal health authorities in the United States have indicated flexibility on expanding the gap between first and second doses to six weeks. But the vaccines in those cases are the same in both doses.

Sputnik, however, developed by the Gamaleya Research Institute, part of Russia’s Ministry of Health, uses a different adenovirus in each of its two doses to deliver bits of the coronavirus’s genetic code. Russia has said it will soon release a one-shot version of its vaccine — essentially using the first dose as the only dose, which it is calling “Sputnik Light.” It is not clear what benefit there would be to delaying a second dose of Sputnik, since there is no recommendation that the second version be administered as a single dose.

Argentina’s decision to delay second doses comes amid increasing concerns of the possibility of a new wave of Covid-19 cases and deaths, fueled by the new variants of the virus that have engulfed several of Argentina’s neighbors, particularly Brazil, but also Chile and Paraguay.

Argentina is canceling all direct flights with Brazil, Chile and Mexico starting Saturday in an effort to block the new variants. It had already blocked flights from Britain and Ireland.

International travelers already face new restrictions in Argentina, including a mandatory Covid-19 test on arrival and enforced quarantine in a hotel if it comes back positive.

One of the busiest metro systems in the world, the London Underground, is operating at around 20 percent of normal.
One of the busiest metro systems in the world, the London Underground, is operating at around 20 percent of normal.Credit…Kirsty Wigglesworth/Associated Press

In London, Piccadilly Circus station is nearly empty on a weekday morning, while the Delhi Metro ferries fewer than half the riders it used to. In Rio, bus drivers are on strike, and in New York City, subway traffic is at just a third of normal volume.

A year into the pandemic, public transit is hanging by a thread in many cities. Riders stay home or remain fearful of the close quarters of buses and trains. Without fares, transit revenues have fallen off a cliff. Service has been cut, fares have risen and transport workers are facing layoffs.

That spells disaster for efforts to combat another urgent global crisis: climate change. Public transit is a relatively simple remedy for urban greenhouse gas emissions, not to mention air quality, noise and congestion.

“We are facing maybe the most important crisis in the public transit sector in different parts of the world,” said Sergio Avelleda, director of urban mobility for the World Resources Institute. “It’s urgent to act.”

But act how? Transit agencies temporarily bailed out by governments wonder how long assistance will last, and experts are scrambling to adapt public transport for cities beginning to emerge from the pandemic.

There are a few outliers. In Shanghai, for example, ridership took a nosedive in February 2020, but has rebounded as new coronavirus infections remain low and the economy improves.

But elsewhere the picture is grim.

On the Paris Metro, ridership was just over half of normal levels early this year. Ile-de-France Mobilites, the regional transport agency, said 2020 losses had reached 2.6 billion euros, or over $3 billion.

Amsterdam’s trams and buses have reached about a third of normal volume. Rome’s Metro is drawing fewer than half of its usual passengers.

The London Underground, one of the world’s busiest, is operating at around 20 percent of its usual four million daily journeys. Buses are at around 40 percent of normal.

“It’s been pretty devastating, to be perfectly honest,” said Alex Williams, London’s director of city planning for transport. “One of our concerns are substantial declines in public transport and higher levels of car use.”

Cities could upgrade transportation systems now so passengers will return, said Mohamed Mezghani, head of the International Association of Public Transport.

“People will feel more comfortable traveling in a new modern public transit system” after the pandemic, Mr. Mezghani said. “It’s about perception in the end.”

A patient is intubated at Hospital Clinicas, a main medical facility in central Porto Alegre, Brazil.
A patient is intubated at Hospital Clinicas, a main medical facility in central Porto Alegre, Brazil. Credit…Mauricio Lima for The New York Times

The patients began arriving at hospitals in Porto Alegre far sicker and younger than before. Funeral homes were experiencing a steady uptick in business, while exhausted doctors and nurses pleaded in February for a lockdown to save lives.

But Sebastiao Melo, Porto Alegre’s mayor, argued there was a greater imperative.

“Put your life on the line so that we can save the economy,” Mr. Melo appealed to his constituents in late February.

Now Porto Alegre, a prosperous city in southern Brazil, is at the heart of a stunning breakdown of the country’s health care system — a crisis foretold.

More than a year into the pandemic, deaths in Brazil are at their peak and highly contagious variants of the coronavirus are sweeping the nation, enabled by political dysfunction, widespread complacency and conspiracy theories. The country, whose leader, President Jair Bolsonaro, has played down the threat of the virus, is now reporting more new cases and deaths per day than any other country in the world.

“We have never seen a failure of the health system of this magnitude,” said Ana de Lemos, the executive director of Doctors Without Borders in Brazil. “And we don’t see a light at the end of the tunnel.”

On Wednesday, the country surpassed 300,000 Covid-19 deaths, with roughly 125 Brazilians succumbing to the disease every hour. Health officials in public and private hospitals were scrambling to expand critical care units, stock up on dwindling supplies of oxygen and procure scarce intubation sedatives that are being sold at an exponential markup.

Singer Dolly Parton wore a sparkly navy blue knit top with cold-shoulder cutouts when she received her vaccination on March 2.
Singer Dolly Parton wore a sparkly navy blue knit top with cold-shoulder cutouts when she received her vaccination on March 2.Credit…@Dollyparton, via Reuters

Look out, Zoom shirt. Here comes the vaccine top.

As millions of more Americans become eligible for the coronavirus vaccine, fashion-minded folks are giving extra consideration to what they will wear for their coveted appointments, and the emerging vaccine-ready top seems to be the cold-shoulder top, thanks to Dolly Parton.

On March 2, the 75-year-old country music star posted a four-minute video across her social media channels, getting her first shot of the Moderna vaccine at Vanderbilt Health in Tennessee.

“Dolly gets a dose of her own medicine,” she wrote on Instagram, a reference to the $1 million she donated last year for coronavirus vaccine research to Vanderbilt University Medical Center, which worked with Moderna.

For the occasion, she wore a sparkly navy blue knit top with cold-shoulder cutouts that was custom designed by her creative director, Steve Summers. “I even have a little cutout in my shirt — I matched it over here,” she told the doctor who administered the shot, pointing to her other shoulder.

Her choice kick-started a vaccine fashion moment. The cold-shoulder may not have seen this much action since the 1990s, when Donna Karan sent Linda Evangelista down a fall 1991 runway wearing a white one under a matching jacket. Women’s Wear Daily called it “silly,” but when Liza Minnelli wore a black version to the 1992 Oscars, followed by Candice Bergen to the Emmys (and then Hillary Clinton, in one of her early looks as the first lady), it struck a glamorously accessible chord. During the early 2000s, it was a staple of the so-called going-out-top trend, when night life held sway over fashion.

These days, the cold-shoulder has less to do with “going out” than the ease with which it allows wearers to be vaccinated. Lyst, the fashion search and shopping platform, has seen searches for cold-shoulder tops increase 21 percent since the start of March, according to a company spokeswoman.

When Wendy Brande, 53, a jewelry designer and activist in New York City, went to get vaccinated at the Javits Convention Center in New York City on March 5, she wore a black cold-shoulder sweater that she bought on eBay around 2005. “I just about fell over when I saw Dolly wearing one,” she said. “I knew I kept it for this moment.”

Apparently, she was not the only one. As she was receiving her Pfizer shot, the nurse told her: “Everyone’s wearing these tops.”

— Mia Adorante

Medical staff prepared to administer vaccines at a drive-though site in Cleveland, Miss., on Wednesday. Biden administration officials are anticipating the vaccine supply to outstrip U.S. demand by mid-May.
Medical staff prepared to administer vaccines at a drive-though site in Cleveland, Miss., on Wednesday. Biden administration officials are anticipating the vaccine supply to outstrip U.S. demand by mid-May.Credit…Rory Doyle for The New York Times

Vaccine manufacturers in the United States are set to overproduce Covid-19 vaccines by late spring as much of the world is still in need of doses. Biden administration officials are anticipating the supply to outstrip U.S. demand by mid-May if not sooner, and are grappling with what to do with the surplus when vaccine scarcity turns to glut.

Many countries around the world are having the opposite issue, and deciding the fate of the extra doses is a question with significant implications for the global fight to end the pandemic.

Of the vaccine doses given worldwide, about three-quarters have gone to only 10 countries. At least 30 countries have not yet injected a single person. And as more countries and regions begin limiting their exports, vaccine shortages, especially in poorer countries, threaten to become more acute.

India, a major supplier of the AstraZeneca vaccine, is holding back nearly all of the 2.4 million doses that the Serum Institute of India produces daily to inoculate its own population as coronavirus cases soar. The decision has set off setbacks for vaccination drives in other countries that don’t have the infrastructure to produce their own vaccines.

Covax, the program set up by donor agencies to purchase vaccines for poorer nations, said on Thursday that it had told those countries that the nearly 100 million doses expected in March and April would face delays because of “increased demand for Covid-19 vaccines in India.”

The European Union this week decided to move on emergency legislation that would curb vaccine exports for the next six weeks to address its own vaccine shortfalls. The bloc has exported more doses to Britain than it has delivered to Germany, and it is starting to see another wave of infections in France and Italy.

Here’s what else we learned this week:

  • People who are fully vaccinated against Covid-19 can still contract the virus, but it’s most likely very rare. “Breakthrough” cases, though quite uncommon, are a sharp reminder that vaccinated people should wear masks while the virus is circulating widely.

  • As many as one-tenth of the people who have died from the virus in New York City may be buried on Hart Island, the city’s potter’s field, according to an analysis of city data.

  • A new study will attempt to determine one of the big unanswered questions about vaccines: Can people immunized against the coronavirus still spread it to others? Researchers said they were recruiting 12,000 students on some 20 U.S. college campuses, about half of whom will be immediately vaccinated and the other half four months later. Participants will swab their noses daily and be tested often, and over time, about 25,000 of their close contacts will also be studied.

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